ROLE OF BRONCHOALVEOLAR LAVAGE IN CHILDREN WITH LUNG-DISEASE

The aim of the present study was to evaluate the clinical role of bron choscopic and nonbronchoscopic bronchoalveolar lavage (BAL) in the dia gnosis of infectious and interstitial lung disease in children, BAL wa s performed using three 1 mL . kg(-1) aliquots of normal saline, with the flexible bronchoscope (Olympus 3.6 or 4.8 mm) wedged in a segmenta l or subsegmental bronchus of the lobe that showed most abnormality on chest radiograph. In seven children with severe diffuse lung disease who were intubated, a nonbronchoscopic suction catheter lavage was per formed. Fluid cultures and cellularity were evaluated using identical methods for both techniques, Between January 1993 and April 1994, 41 B AL were performed in 32 children aged 2 months to 17 yrs (median 8 yrs ), Of these lavages, 14 were in heart and heart-lung transplant recipi ents, 11 in children known to be immunocompromised, and 16 in children who had a lung biopsy for interstitial lung disease or who had presum ed infective lung disease, Transbronchial biopsies (TBB) or open lung biopsies were performed coincident with 19 BAL procedures, In all tran splant recipients without clinical symptoms, BAL and TBB cultures were negative and BAL cellularity was normal, TBB did not reveal infection or rejection in any of these patients, A diagnosis of infection was m ade by BAL in 1 out of 8 transplant recipients with clinical symptoms, and a diagnosis of rejection was made by TBB in 3 out of 8 patients, In 6 out of 11 BAL in immunocompromised children, an infectious agent was found in the BAL fluid, In three other patients who had an open lu ng biopsy, an interstitial lung disease was diagnosed. In these patien ts, BAL was abnormal but not diagnostic, In summary, BAL proved helpfu l in the diagnosis of infective lung disease, but had little value in the diagnosis of rejection or parenchymal noninfective lung disease in children.