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Bronchoalveolar Lavage: Role in the Pathogenesis, Diagnosis, and Management of Interstitial Lung Disease

RONALD P. DANIELE, M.D.; JACK A. ELIAS, M.D.; PAUL E. EPSTEIN, M.D.; and MILTON D. ROSSMAN, M.D.
[+] Article and Author Information

Grant support: in part by Research Career Development Award HL-00210 and HL-30715 to Dr. Daniele, and Clinical Investigator Awards HL-01064 to Dr. Elias and HL-31136 to Dr. Rossman, from the National Institutes of Health.

▸Requests for reprints should be addressed to Ronald P. Daniele, M.D.; 807 East Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce Street; Philadelphia, PA 19104.


Philadelphia, Pennsylvania


© 1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;102(1):93-108. doi:10.7326/0003-4819-102-1-93
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Bronchoalveolar lavage has emerged as a useful technique for the study of pulmonary interstitial disorders. Several types of information are provided by the evaluation of lavage fluid. First, the identification of cellular constituents helps to separate inflammatory processes in which lymphocytes predominate (for example, sarcoidosis, hypersensitivity pneumonitis, and berylliosis) from those in which neutrophils or macrophages predominate (for example, idiopathic pulmonary fibrosis and histiocytosis X). Second, the cells removed during lavage can be studied for their immune properties and function; tested with specific antigens, in diseases such as berylliosis and hypersensitivity pneumonitis; and examined for the presence of unique surface antigens with monoclonal antibodies (for example, histiocytosis X). Third, in conjunction with scanning electron microscopy and electron probe analysis, lavage makes possible the identification of inorganic particles in alveolar macrophages of patients with pneumoconiotic lung disease. Finally, although lavage is still an investigative procedure for most pulmonary disorders, it has an established role in the diagnosis of opportunistic infections in the immunocompromised patient.

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