Basic principles and technique of bronchoalveolar lavage
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
Bronchoalveolar lavage (BAL), performed during flexible bronchoscopy, has gained widespread acceptance as a minimally invasive method that provides important information about immunologic, inflammatory, and infectious processes taking place at the alveolar level . Studies comparing BAL cellular constituents to cells obtained from open lung biopsy have shown that the cell types and their state of activation are similar with either collection method.
This review will consider the basic principles and technique of BAL. The utility of this procedure in individual diseases is discussed in the appropriate topic reviews. The use of preprocedure medication, topical anesthesia of the upper airway, and techniques for the passage of the bronchoscope into the lung are discussed elsewhere. (See "Flexible bronchoscopy in adults: Indications and contraindications" and "Flexible bronchoscopy in adults: Overview".)
Bronchoalveolar lavage (BAL) has been widely used in patients with a variety of lung diseases . Advantages with this technique include its noninvasive nature and ability to readily sample alveolar contents.
As a result, it has an important role in management of diffuse lung diseases for the following reasons [3,4]:
●It is an excellent method to obtain specimens to rule out opportunistic infections in immunocompromised hosts 
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- PATIENT SELECTION
- Optimal site
- Fluid instillation
- Fluid recovery
- PROCESSING THE LAVAGE SPECIMEN
- CELL COUNTING
- Initial processing
- Total cell counts
- Differential cell counts
- Adequacy of BAL
- Data expression
- Noncellular components of BAL
- Lymphocyte subpopulations and immunohistochemistry
- NORMAL BAL CELL COUNTS
- MICROBIOLOGIC ANALYSIS
- CYTOLOGIC ANALYSIS
- BERYLLIUM LYMPHOCYTE PROLIFERATION TEST
- ADVERSE EFFECTS
- SUMMARY AND RECOMMENDATIONS