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. 1987 Oct;42(10):766–772. doi: 10.1136/thx.42.10.766

Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants.

H J Milburn 1, H G Prentice 1, R M du Bois 1
PMCID: PMC460949  PMID: 2827335

Abstract

Forty episodes of pneumonitis in 30 recipients of allogeneic bone marrow transplants were investigated by fibreoptic bronchoscopy and bronchoalveolar lavage. A positive diagnosis was made in 32 episodes of pneumonitis (24 patients), giving a diagnostic yield of 80%. In 31 of these the diagnosis was made within 24 hours of bronchoscopy and this enabled the appropriate treatment to be instituted early. Eighteen patients recovered from their primary infection, although two died subsequently of respiratory failure due to postpneumonic lung destruction. Ten patients later developed a second episode of pneumonitis and a diagnosis was made in nine of these. Only three survived a second episode. Bronchoalveolar lavage was well tolerated by all patients and there was no morbidity or mortality that could be directly attributed to the procedure. Bronchoalveolar lavage is a safe and valuable early diagnostic procedure for the investigation of pulmonary complications in patients who have received bone marrow transplants.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen H. A., Fontana R. S. Transbronchoscopic lung biopsy for diffuse pulmonary diseases: technique and results in 450 cases. Chest. 1972 Aug;62(2):125–128. doi: 10.1378/chest.62.2.125. [DOI] [PubMed] [Google Scholar]
  2. Blacklock H. A., Griffiths P., Stirk P., Prentice H. G. Specific hyperimmune globulin for cytomegalovirus pneumonitis. Lancet. 1985 Jul 20;2(8447):152–153. doi: 10.1016/s0140-6736(85)90252-1. [DOI] [PubMed] [Google Scholar]
  3. Broaddus C., Dake M. D., Stulbarg M. S., Blumenfeld W., Hadley W. K., Golden J. A., Hopewell P. C. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Jun;102(6):747–752. doi: 10.7326/0003-4819-102-6-747. [DOI] [PubMed] [Google Scholar]
  4. Cardozo B. L., Hagenbeek A. Interstitial pneumonitis following bone marrow transplantation: pathogenesis and therapeutic considerations. Eur J Cancer Clin Oncol. 1985 Jan;21(1):43–51. doi: 10.1016/0277-5379(85)90199-3. [DOI] [PubMed] [Google Scholar]
  5. Coleman D. L., Dodek P. M., Luce J. M., Golden J. A., Gold W. M., Murray J. F. Diagnostic utility of fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome. Am Rev Respir Dis. 1983 Nov;128(5):795–799. doi: 10.1164/arrd.1983.128.5.795. [DOI] [PubMed] [Google Scholar]
  6. Cunningham J. H., Zavala D. C., Corry R. J., Keim L. W. Trephine air drill, bronchial brush, and fiberoptic transbronchial lung biopsies in immunosuppressed patients. Am Rev Respir Dis. 1977 Feb;115(2):213–220. doi: 10.1164/arrd.1977.115.2.213. [DOI] [PubMed] [Google Scholar]
  7. Daniele R. P., Elias J. A., Epstein P. E., Rossman M. D. Bronchoalveolar lavage: role in the pathogenesis, diagnosis, and management of interstitial lung disease. Ann Intern Med. 1985 Jan;102(1):93–108. doi: 10.7326/0003-4819-102-1-93. [DOI] [PubMed] [Google Scholar]
  8. Davidson M., Tempest B., Palmer D. L. Bacteriologic diagnosis of acute pneumonia. Comparison of sputum, transtracheal aspirates, and lung aspirates. JAMA. 1976 Jan 12;235(2):158–163. [PubMed] [Google Scholar]
  9. Davis G. S., Kelley J. Invasive techniques for the diagnosis of respiratory infections. Clin Lab Med. 1982 Jun;2(2):269–283. [PubMed] [Google Scholar]
  10. Flick M. R., Wasson K., Dunn L. J., Block A. J. Fatal pulmonary hemorrhage after transbronchial lung biopsy through the fiberoptic bronchoscope. Am Rev Respir Dis. 1975 Jun;111(6):853–856. doi: 10.1164/arrd.1975.111.6.853. [DOI] [PubMed] [Google Scholar]
  11. Griffiths P. D., Panjwani D. D., Stirk P. R., Ball M. G., Ganczakowski M., Blacklock H. A., Prentice H. G. Rapid diagnosis of cytomegalovirus infection in immunocompromised patients by detection of early antigen fluorescent foci. Lancet. 1984 Dec 1;2(8414):1242–1245. doi: 10.1016/s0140-6736(84)92797-1. [DOI] [PubMed] [Google Scholar]
  12. Hopkin J. M., Turney J. H., Young J. A., Adu D., Michael J. Rapid diagnosis of obscure pneumonia in immunosuppressed renal patients by cytology of alveolar lavage fluid. Lancet. 1983 Aug 6;2(8345):299–301. doi: 10.1016/s0140-6736(83)90287-8. [DOI] [PubMed] [Google Scholar]
  13. Kalinske R. W., Parker R. H., Brandt D., Hoeprich P. D. Diagnostic usefulness and safety of transtracheal aspiration. N Engl J Med. 1967 Mar 16;276(11):604–608. doi: 10.1056/NEJM196703162761103. [DOI] [PubMed] [Google Scholar]
  14. Kelley J., Landis J. N., Davis G. S., Trainer T. D., Jakab G. J., Green G. M. Diagnosis of pneumonia due to Pneumocystis by subsegmental pulmonary lavage via the fiberoptic bronchoscope. Chest. 1978 Jul;74(1):24–28. doi: 10.1378/chest.74.1.24. [DOI] [PubMed] [Google Scholar]
  15. Leight G. S., Jr, Michaelis L. L. Open lung biopsy for the diagnosis of acute, diffuse pulmonary infiltrates in the immunosuppressed patient. Chest. 1978 Apr;73(4):477–482. doi: 10.1378/chest.73.4.477. [DOI] [PubMed] [Google Scholar]
  16. Meyers J. D., Flournoy N., Thomas E. D. Nonbacterial pneumonia after allogeneic marrow transplantation: a review of ten years' experience. Rev Infect Dis. 1982 Nov-Dec;4(6):1119–1132. doi: 10.1093/clinids/4.6.1119. [DOI] [PubMed] [Google Scholar]
  17. Neiman P. E., Reeves W., Ray G., Flournoy N., Lerner K. G., Sale G. E., Thomas E. D. A prospective analysis interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts. J Infect Dis. 1977 Dec;136(6):754–767. doi: 10.1093/infdis/136.6.754. [DOI] [PubMed] [Google Scholar]
  18. Prentice H. G., Blacklock H. A., Janossy G., Gilmore M. J., Price-Jones L., Tidman N., Trejdosiewicz L. K., Skeggs D. B., Panjwani D., Ball S. Depletion of T lymphocytes in donor marrow prevents significant graft-versus-host disease in matched allogeneic leukaemic marrow transplant recipients. Lancet. 1984 Mar 3;1(8375):472–476. doi: 10.1016/s0140-6736(84)92848-4. [DOI] [PubMed] [Google Scholar]
  19. Puksa S., Hutcheon M. A., Hyland R. H. Usefulness of transbronchial biopsy in immunosuppressed patients with pulmonary infiltrates. Thorax. 1983 Feb;38(2):146–150. doi: 10.1136/thx.38.2.146. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shepp D. H., Dandliker P. S., de Miranda P., Burnette T. C., Cederberg D. M., Kirk L. E., Meyers J. D. Activity of 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Ann Intern Med. 1985 Sep;103(3):368–373. doi: 10.7326/0003-4819-103-3-368. [DOI] [PubMed] [Google Scholar]
  21. Sloane J. P., Depledge M. H., Powles R. L., Morgenstern G. R., Trickey B. S., Dady P. J. Histopathology of the lung after bone marrow transplantation. J Clin Pathol. 1983 May;36(5):546–554. doi: 10.1136/jcp.36.5.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Spencer C. D., Beaty H. N. Complications of transtracheal aspiration. N Engl J Med. 1972 Feb 10;286(6):304–306. doi: 10.1056/NEJM197202102860607. [DOI] [PubMed] [Google Scholar]
  23. Stover D. E., White D. A., Romano P. A., Gellene R. A. Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage. Am Rev Respir Dis. 1984 Oct;130(4):659–662. doi: 10.1164/arrd.1984.130.4.659. [DOI] [PubMed] [Google Scholar]
  24. Stover D. E., Zaman M. B., Hajdu S. I., Lange M., Gold J., Armstrong D. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med. 1984 Jul;101(1):1–7. doi: 10.7326/0003-4819-101-1-1. [DOI] [PubMed] [Google Scholar]
  25. Wallace J. M., Batra P., Gong H., Jr, Ovenfors C. O. Percutaneous needle lung aspiration for diagnosing pneumonitis in the patient with acquired immunodeficiency syndrome (AIDS). Am Rev Respir Dis. 1985 Mar;131(3):389–392. doi: 10.1164/arrd.1985.131.3.389. [DOI] [PubMed] [Google Scholar]
  26. Williams D., Yungbluth M., Adams G., Glassroth J. The role of fiberoptic bronchoscopy in the evaluation of immunocompromised hosts with diffuse pulmonary infiltrates. Am Rev Respir Dis. 1985 Jun;131(6):880–885. doi: 10.1164/arrd.1985.131.6.880. [DOI] [PubMed] [Google Scholar]
  27. Winston D. J., Gale R. P., Meyer D. V., Young L. S. Infectious complications of human bone marrow transplantation. Medicine (Baltimore) 1979 Jan;58(1):1–31. doi: 10.1097/00005792-197901000-00001. [DOI] [PubMed] [Google Scholar]
  28. Zavala D. C. Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest. 1976 Nov;70(5):584–588. doi: 10.1378/chest.70.5.584. [DOI] [PubMed] [Google Scholar]

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