The site of bronchoalveolar lavage determines its diagnostic value in patients with collagen vascular diseases and alveolitis

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 37 (F 46). 1998;

Abstract: Department of Medicine and 1Department of Radiology Charité University Hospital Berlin Objective: Bronchoalveolar lavage (BAL) of the middle lobe (ML) is frequently used for the diagnosis of alveolitis. However in patients with collagen-vascular diseases (CVD) this BAL site may not always give representative results since alveolitis in CVD is mostly localized in the posterior lower zones of the lung. We therefore compared the diagnostic significance of lower lobe (LL) BAL and middle lobe BAL in the assessment of alveolitis in CVD patients with interstitial lung disease of the lower lung zones. Methods: Fifty-seven non-smoking patients with CVD (48 females 9 males 40 systemic sclerosis 5 systemic lupus erythematosus 12 primary Sjögren's syndrome) were included in the study. Patients were divided into three groups according to the HR-CT findings of the right lung. Group 1 included 28 patients with reticular and/or ground glass opacities and/or honeycomb pattern in the posterior lower zones only and without any pathological interstitial changes in the anterior zones. Group 2 included 13 patients with pathological CT-patterns in both the posterior and anterior lower zones of the lungs. Group 3 included 16 patients with normal interstitial CT-patterns. The control group included 12 subjects without lung disease (8 males 4 females). BAL of LL and ML of the right lung was performed within the same session starting with LL BAL. Total cell count was determined and cell differentials were performed following slide staining with May-Grünwald-Giemsa-solution. Results: In patients with interstitial lung disease of the posterior lower zone only (group 1) percentages of neutrophils and eosinophils in LL BAL were significantly increased (p < 0.001) and the percentage of macrophages in LL BAL was decreased (p < 0.05) as compared to ML BAL. ... le

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