Bronchoalveolar lavage: role in the evaluation of pulmonary interstitial disease

ABSTRACT

Introduction

Bronchoalveolar lavage (BAL), a noninvasive, well-tolerated procedure is an important diagnostic tool that can facilitate the diagnosis of various lung diseases. This procedure allows the assessment of large alveolar compartments, by providing cells as well as non-cellular constituents from the lower respiratory tract. Alterations in BAL fluid and cells ratio reflects pathological changes in the lung parenchyma. In some cases, clinicians use BAL as a differential diagnosis guide for interstitial lung disease.

Areas covered

In this review, we summarized the diagnostic criteria for BAL in interstitial lung diseases, pulmonary infections, lung cancer and other pathologies such as fat embolism, gastroesophageal reflux and collagen vascular disease. For this review, we have selected scientific papers published in the PubMed database in our area of interest. We aimed to highlight the usefulness of BAL in respiratory pathology.

Expert opinion

Although BAL fluid analyzes has an essential role in the diagnostic work-up of many lung pathologies, it should be performed in selected patients. For accurate results, the BAL technique is very important to be standardized.

KEYWORDS:

• Bronchoalveolar lavage
• interstitial lung disease
• hypersensitivity pneumonitis
• sarcoidosis
• pulmonary alveolar proteinosis

Article highlights

• This paper aims to present the usefulness of BAL in respiratory pathology.

• As many pathologies as possible are included in this review. In order to achieve this, an important number of existing scientific papers in the literature were analyzed.

• It was important to make a diagnostic diagram of BAL.

• Microscopic images of BAL analyzes are included in this paper.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Stanca-Patricia Hogea: selected the articles included in the review and wrote the draft.

Emanuela Tudorache: reviewed and edited the final draft and provided supervision of the activity. Camelia Pescaru and Monica Marc: analyzed the selected articles and led the analyzes of the collected data. Cristian Oancea: managed and coordinated the research activity and provided validation of the final results.

Additional information

Funding

This paper was not funded.