The Diagnostic Utility of Bronchoalveolar Lavage in Immunocompetent Children With Unexplained Infiltrates on Chest Radiograph

Abstract

To assess the diagnostic utility of bronchoalveolar lavage (BAL) in a heterogeneous group of immunocompetent children with unexplained infiltrates on chest radiograph. This was a retrospective case series. The setting was a tertiary care referral center in an urban children's hospital. Twenty-five consecutive children, median age 4 years 6 months, had flexible bronchoscopy with BAL. Preprocedure diagnoses were right middle-lobe syndrome (3 patients), granulomatous lung disease (3 patients), adult respiratory distress syndrome (3 patients), and persistent infiltrate on chest x-ray (16 patients). The majority of patients were receiving parenteral antibiotics before bronchoscopy. BAL fluid was sent for bacterial, viral, fungal, and, if indicated, mycobacterial cultures. Twenty-seven procedures were performed in 25 patients. A specific diagnosis was made in eight (30%) of the procedures. Four patients had viral infections, two had fungal infections, one had a bacterial infection, and one had a mixed fungal and bacterial infection. Submitting BAL fluid for bacterial, viral, and fungal culture can be helpful in diagnosing infection in immunocompetent children. Empiric antibiotic therapy remains the standard treatment for pneumonia in children. Bronchoalveolar lavage may yield a diagnosis in patients unresponsive to empiric antibiotics. Careful selection of patients, a bronchoscopist skilled in the procedure, and the risk/benefit ratio all must be considered.