Chest
Clinical InvestigationsDiagnostic Value of Bronchoalveolar Lavage in Suspected Pulmonary Tuberculosis
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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Post-bronchoscopy sputum: Improving the diagnostic yield in smear negative pulmonary TB
2011, Respiratory MedicineCitation Excerpt :Little is known about the clinical utility of sputum sampling after bronchoscopy (post-bronchoscopy sputum – PBS) and its diagnostic potential in smear negative PTB suspects. Two previous studies have examined the yield of various techniques including PBS for the diagnosis of smear negative PTB12,13 but numbers were small (n = 13–25) and as a result conclusions regarding its potential value are difficult to establish. One larger study in Ethiopia has also previously investigated PBS sampling in AFB smear negative TB suspects but only included HIV infected individuals14; post-bronchoscopy sputum culture provided comparable results to BAL culture in this setting.
Diagnosis of pulmonary tuberculosis in a microbiological laboratory
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Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD<sup>®</sup> Gen-probe testing
2011, Respiratory MedicineCitation Excerpt :The diagnosis of pulmonary TB can be obtained from microscopy and culture of a number of different sources including regular sputum, induced sputum, gastric washings and bronchoscopy. The sensitivity, specificity and diagnostic yield of each of these tests vary widely between studies.1–7 Sputum microscopy and culture are relatively easy to perform but can be negative in a substantial proportion of pulmonary TB patients with reported sensitivities ranging from 25 to 45%.1,8,9
Bronchoscopy and Lung Biopsy in Critically Ill Patients
2008, Critical Care Medicine: Principles of Diagnosis and Management in the Adult
Manuscript received December 29; revision accepted July 7.