Chest Infections |

Factors Affecting Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Patients FREE TO VIEW

Kyle Brownback*, MD; Steven Simpson, MD
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University of Kansas Medical Center, Kansas City, KS

Chest. 2012;142(4_MeetingAbstracts):187A. doi:10.1378/chest.1354672
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SESSION TYPE: AIDS/ Immunocompromised Patients Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Volume retrieved from bronchoalveolar lavage (BAL) is higher in the middle lobes than the lower lobes. In HIV patients with pneumonia due to Pneumocystis jirovecci, BAL diagnostic yield is higher when performed in the affected lobe. We sought to determine factors that affect diagnostic yield of BAL in all immunocompromised patients.

METHODS: Retrospective chart review of patients who underwent fiberoptic bronchoscopy (FOB) with BAL from 1/1/2010 to 12/31/2011 at an academic medical center was performed. Patients who were immunocompromised were selected. BAL was performed in the segment of the lobe most affected by the predominant pulmonary process. Lobe of lung lavaged, characteristics of pulmonary infiltrate on radiograph, patient symptoms, and diagnostic yield were collected. Chi-squared test was performed for categorical data.

RESULTS: 132 patients underwent 150 FOB with BAL during the 2 year period. 73 patients received stem cell transplantation, 21 patients received solid organ transplant, 51 patients were receiving chemotherapy, 8 patients had HIV, and 5 patients had autoimmune disease and were receiving immunosuppressants. The diagnostic yield was 57.3% and there was no significant difference in diagnostic yield from any particular lobe of the lung (p=0.4113.) Diagnostic yield was 54.1% from the upper lobes (39/72), 52.4% from the right middle lobe (22/42) and 69.4% from the lower lobes (25/36.) The diagnostic yield was significantly improved in patients with both fever and chest symptoms compared to patients without either symptom (65.3% versus 33.3%, p=0.0159). Infiltrates that were predominantly reticular or nodular had a lower diagnostic yield than those that were predominantly consolidated, ground glass or tree-in-bud (38.5%, 20/52 vs. 67.3%, 66/98; p=0.003.)

CONCLUSIONS: Location of the lobe in which BAL is performed in immunocompromised patients does not affect diagnostic yield. Predominantly reticular and nodular infiltrates have significantly worse diagnostic yield than those that are alveolar in nature. Symptomatic patients are more likely to have diagnostic FOB with BAL than those without.

CLINICAL IMPLICATIONS: BAL has a higher yield on alveolar processes as opposed to interstitial processes in immunocompromised patients.

DISCLOSURE: The following authors have nothing to disclose: Kyle Brownback, Steven Simpson

No Product/Research Disclosure Information

University of Kansas Medical Center, Kansas City, KS




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