Chest
Volume 93, Issue 2, February 1988, Pages 329-332
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Clinical Investigations
Diagnostic Value of Bronchoalveolar Lavage in Suspected Pulmonary Tuberculosis

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Of 222 patients suspected of having pulmonary tuberculosis (PT), studied during a one-year period, we performed fiberoptic bronchoscopy together with bronchoalveolar lavage (BAL), bronchial washing and postbronchoscopy sputum smears and Löwenstein cultures in 20 patients. Bronchoalveolar lavage proved to be the most effective method leading to diagnosis in 17 of 20 cases. Diagnosis was obtained in 11 of 20 cases using bronchial washing and postbronchoscopy sputum. The results of this study suggest that bronchoscopy may be required in selected cases for the diagnosis of PT. However, it should be accompanied by BAL, bronchial washings and postbronchoscopy sputum smears. Indications for bronchoscopy as a diagnostic tool for PT may include: (a) patients suspected of having PT with negative smears and in whom treatment must be started due to clinical status; (b) suspicion of associated neoplasia; (c) selected patients with negative Löwenstein cultures; (d) lack of material being obtained by simpler methods.

Section snippets

Patient Selection

From January to December of 1985 pulmonary tuberculosis was suspected in 222 patients (Fig 1) in a 1,000-bed general hospital covering a large urban area. Bronchoalveolar lavage was performed in 20 cases (nine percent), 12 males and eight females aged 17 to 71 years (mean age, 42 ± 18 years), which constituted the study group (Table 1). Indications for bronchoscopy in this group were three negative consecutive early morning sputum or gastric aspirate smears for acid-fast bacilli prior to the

RESULTS

Table 2 shows the relative yield of the three bronchoscopic procedures: BAL, bronchial washing and postbronchoscopy sputum smears. The combination of the three established the diagnosis in 19 of 20 cases (95 percent); 16 had PT and three, a lung neoplasm. One patient (case 9) underwent an open lung biopsy due to the negativity of the three procedures and transbronchial biopsy, and was eventually diagnosed as having PT on the basis of the biopsy culture in Löwenstein medium.

Sixteen of 17

DISCUSSION

Fiberoptic bronchoscopy is of proven value in the diagnosis of various conditions involving the lung parenchyma. Bronchoalveolar lavage has been used as a safe method to study the alveolar cellular contents in both healthy subjects and patients with interstitial pulmonary disease, and has been used to study the involved inflammatory and immunologic factors.11, 12 More recently, BAL has proved to be useful in the study of pulmonary infiltrates in immunosuppressed patients, in recognizing

ACKNOWLEDGMENT

We are grateful to Manuel Ballester, M.D., for his help and advice in the preparation of the manuscript.

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Manuscript received December 29; revision accepted July 7.

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