What is the role of bronchoalveolar lavage in the workup of restrictive lung disease?

Updated: Sep 16, 2020
  • Author: Jonathan Robert Caronia, DO; Chief Editor: John J Oppenheimer, MD  more...
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In selected cases, bronchoalveolar lavage (BAL) cellular analysis may be helpful to narrow the differential diagnosis. However, the utility of BAL in the clinical assessment and management of interstitial lung diseases remains to be established.

Performing BAL lymphocytosis in patients with IPF may help predict steroid responsiveness. A predominance of T lymphocytes with an elevated CD4-to-CD8 ratio is characteristic but not diagnostic of sarcoidosis. Significant BAL lymphocytosis suggests the presence of a granulomatous interstitial lung disease, suggestive of hypersensitivity pneumonitis, a drug reaction ,or cellular nonspecific interstitial pneumonitis.

BAL fluid may contain malignant cells, asbestos bodies, eosinophils, and hemosiderin macrophages, which assist in making a diagnosis. A progressively bloody lavage specimen would support a diagnosis of diffuse alveolar hemorrhage.

A primary role of BAL in the management of interstitial lung disease is to rule out infection. BAL fluid is highly sensitive for bacterial, viral, fungal, and mycobacterial diseases.

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