ISBN: 90-9014494-3

Bronchoalveolar lavage (BAL)
BAL explores large areas of the alveolar compartment providing cells as well as non-cellular constituents from the lower respiratory tract. It opens a window to the lung. Alterations in BAL fluid and cells reflect pathological changes in the lung parenchyma. BAL has been appreciated worldwide in diagnostic work-up of infectious and non-infectious interstitial lung diseases. It is a safe, easily performed, minimally invasive, and well tolerated procedure. In this respect, when the clinician decides that a BAL might be helpful to provide diagnostic material, it is mandatory to consider the provided information obtained from BAL fluid analysis carefully and to have reliable diagnostic criteria.

Interpretation
The interpretation of BAL fluid cytology has to be standardized to improve the diagnostic power.It is with this background that the concept for this CD-rom was developed. It is aimed mainly at clinicians who are having to deal with the diagnostic problems of patients with diffuse interstitial lung diseases. The introductory sections summarize the history of BAL. Furthermore, the importance of standardization of handling BAL samples will be discussed. Additionally, BAL fluid cytology features are presented and the interpretation of the BAL fluid cell differentials is discussed.

Computer program
A validated computer program based on logistic regression analysis using BAL fluid analysis results to distinguish between the three most common interstitial lung diseases: sarcoidosis, idiopathic pulmonary fibrosis, extrinsic allergic alveolitis (EAA) or drug-induced pneumonitis was developed. One of the limitations of this program was that it was not useful in discriminating between infectious disorders and non-infectious disorders.

Clinical setting
Also, it is important to consider BAL cell differentials not in isolation but in the context of the clinical setting and the radiological, particularly the HR-CT appearance of the disease. For example, if the CT scan shows a patchy ground glass pattern, BAL may be able to reveal that this patient suffers from extrinsic allergic alveolitis (high lymphocyte count), or a smoking related respiratory bronchiolitis/ interstitial lung disease (high smoker’s macrophage count and normal cell differential), or alveolar haemorrhage (high count of haemosiderin laden macrophages).

BAL fluid cytology in ild
This CD-rom interpretation of BAL fluid cytology is exactly using such an approach. The work provides a detailed insight into the specific morphologic features of BAL and the interpretation of the BAL cell differentials and also presents illustrative cases with their clinical profile and characteristic imaging findings. We hope that this work will find a warm appreciation amongst chest physicians, pathologists, laboratory technicians, in short, amongst everybody involved in the work-up and interpretation of BAL fluid cytology.

Advice
Although details hidden in BAL fluid may add useful information about a patient’s disorder, the results should be considered in the context of other information from conventional investigative methods and the individual’s unique history. To establish the diagnosis a thorough history is essential as it may identify a potential aetiological factor.

Marjolein Drent,Ulrich Costabel, 2001

Download
For more information you can download the brochure. It is possible to download the software useful by the interpretation of BAL fluid analysis result. First you have to download it and then you can use it at your computer. Start Download

How to order
You can order this CD at the ild care foundation. For further information please contact: info@ildcare.nl.