Bronchoalveolar Lavage Cytology Research Articles

Bilateral bronchoalveolar lavage cytology profiles in a warmblood horse population during a 1-year period.

Bronchoalveolar lavage (BAL) cytology results from 1 lung might not be representative of both lungs. To determine whether the lung site sampled would influence the horse's BAL cytology profile, and if a pooled BAL sample would be superior with regard to BAL cytology diagnosis in a cohort of healthy and subclinical asthmatic warmblood horses. Fifty-nine horses in 2021 and 70 horses in 2022, the follow-up included 53 of the same in each year. A cross-sectional study with follow-up included BAL cytology samples from individual lungs and from pooled BAL samples. The BAL samples were enumerated and differential cell count were applied to categorize the horses as control or with airway inflammation (AI). Bronchoalveolar lavage mast cell count was higher in left lung compared to right lung (2021; median 1.6 [range, 0.6-3.3] vs 1.2 [0.7-1.5] P = .009, 2022; median 3.1 [2.1-4.2] vs 2.4 [1.7-3.4], P < .001) and compared to pooled samples (2022; median 2.6 [1.7-3.7], P < .001). Between year 2021 and 2022, 17 of the horses had changes in BAL cytology from control to AI or vice versa. Pooled BAL sample was the least reliable for detecting AI, and was not representative of the overall lung condition.

Bullous pemphigoid as a paraneoplastic manifestation of metastatic adenocarcinoma of the lung

A 73-year-old male smoker presented with complaints of fever and multiple clear fluid-filled lesions for 3 months. He was initially being treated for primary bullous pemphigoid but lesions recurred. On a chest X-ray, he was found to have a right hilar mass, and contrast-enhanced computed tomography of the chest revealed a right lung mass lesion with cervical, hilar, and mediastinal lymphadenopathy. A bronchoscopy was done, and bronchoalveolar lavage cytology was suggestive of lung adenocarcinoma. An excision biopsy of the left supraclavicular lymph node showed features consistent with adenocarcinoma lung. Hence, he was diagnosed with metastatic adenocarcinoma of the lung with bullous pemphigoid as a paraneoplastic manifestation. He was subsequently treated with chemotherapy, and his skin lesions resolved.

Bronchoalveolar Lavage Fluid Cytology of Deployed Military Personnel With Chronic Respiratory Symptoms From the STAMPEDE III Study.

Deployed military personnel may be at risk for developing acute and chronic lung disease. Prior studies of this patient population have revealed that unexplained exertional dyspnea is the most common diagnosis despite an extensive evaluation. There is a concern that an occult disorder may be affecting this population. This study evaluated the role for bronchoalveolar lavage (BAL) fluid analysis in the evaluation of chronic deployment-associated dyspnea. Military personnel who reported chronic respiratory symptoms were evaluated as part of the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures III study. Participants underwent bronchoscopy with BAL as part of a standardized evaluation. A total of 308 patients with a mean age of 38 ± 8.6 years underwent bronchoscopy with BAL. BAL cell-count percentages of macrophages, lymphocytes, neutrophils, and eosinophils were: 76.2 ± 17.0%, 16.3 ± 13.4%, 6.6 ± 8.9%, and 0.9 ± 3.2%, respectively. There was no clear differentiation between groups based on increases in lymphocyte counts (P = .640), although lymphocyte values were more elevated (21.4 ± 12.1%) in the interstitial lung disease category. Neutrophil counts (6.6 ± 8.9%) were elevated compared to the reported normal reference values and were increased in the isolated pulmonary function test abnormality (9.4 ± 11.6%), large airway disorder (10.0 ± 7.5%), miscellaneous (10.9 ± 20.2%), and obstructive lung disease (11.0 ± 15.6%) groups. Eosinophil counts were within normal limits (0.9 ± 3.2%) and showed no differences between groups (P = .545); asthma patients trended higher (1.6 ± 5.7%). BAL counts for the exertional dyspnea group were within normal reference values and showed no differences from the entire cohort. The addition of BAL cytology did not help differentiate those patients with unexplained dyspnea from other etiologies.

Evaluation of Bronchoalveolar Lavage Cytology and Comparison with Endobronchial Biopsy

Introduction: Early diagnosis of infective etiology and lung cancer plays a vital role in reducing mortality rate of lower respiratory tract disease. Different modalities can be applied for early diagnosis e.g. bronchoalveolar lavage and endobronchial biopsy. Cytological and histopathological diagnostic techniques are safer, economical and provide appropriate results.&#x0D; Aims: To find out diagnostic yield of bronchoalveolar lavage cytology in diagnosing lung pathology and to determine its sensitivity, and specificity in malignant cases considering endobronchial biopsy as the gold standard.&#x0D; Methods: This hospital based analytical study was carried out in the Department of Pathology at Nepalgunj medical college, Nepalgunj during the period from January 2023 to September 2023 with a total of 50 participants.&#x0D; Results: 29(58%) patients were male and 21(42%) female; the mean age was 53.16 ± 19.9 years. Considering histopathological findings, maximum patients of malignant cases had squamous cell carcinoma 3(6%), then adenocarcinoma 1(2%). The sensitivity, specificity, positive and negative predictive value of bronchoalveolar lavage in malignant cases were 75%, 100%, 100% and 50% respectively.&#x0D; Conclusion: Bronchoalveolar lavage fluid cytology is a useful tool for diagnosis of lung cancer. It has good sensitivity, and specificity, and shows nearly identical information as biopsy.

Comparative analysis of cytology of rat bronchoalveolar lavage fluid after single exposure to metal oxide nanoparticles

Introduction. Human production activities (metallurgical, mining, electronics production and processing, batteries) are related to air pollution of the working area and the environments of complex composition aerosols. Among the aerosol components, ultrathin particles of the nanometer range (including metal nano-oxides) are considered to be the most dangerous. Due to their prevalence, study to assess the cytotoxicity of metal oxide nanoparticles are relevant.&#x0D; Material and methods. CuO, PbO, CdO, Fe2O3, NiO nanoparticle (NP) suspension were obtained by laser ablation. The study was done on white outbred female rats. A single intratracheal instillation of different chemical NPs was performed (in dose 0.5 mg/animal); control animals received a similar amount of deionized water. A day after the NP instillation bronchoalveolar lavage (BAL) was carried out with the subsequent assessment of its cytological indices.&#x0D; Results. The cytotoxic action of the studied NPs, based on the cytological indices of the BAL fluid, is changed as follows (from greater to lesser): CuO NP &gt; CdO NP &gt; PbO NP &gt; NiO NP &gt; Fe2O3 NP.&#x0D; Limitations. Such physical characteristics of nanoparticles as solubility in water and biological fluids, charge, adsorption capacity, resistance to aggregation, hydrophobicity, adhesion to surfaces, and the ability to generate free radicals have not been studied. Extrapolation of data from rodents to humans shall be done with caution, since cytotoxicity has been characterized only based on the main cellular parameters.&#x0D; Conclusion. Bronchoalveolar lavage cytology can be used as an effective screening method for the cytotoxic effect of NPs.

Sclerosing epithelioid fibrosarcoma associated with WRN gene variant presenting as chronic dyspnea and pathologic cervical fracture: a case report and review of the literature

BackgroundSclerosing epithelioid fibrosarcoma is an aggressive sarcoma subtype with poor prognosis and limited response to conventional chemotherapy regimens. Diagnosis can be difficult owing to its variable presentation, and cases of sclerosing epithelioid fibrosarcoma are rare. Sclerosing epithelioid fibrosarcoma typically affects middle-aged individuals, with studies inconsistently citing gender predominance. Sclerosing epithelioid fibrosarcoma typically arises from the bones and soft tissues and often has local recurrence after resection and late metastases. Immunohistochemical staining typically is positive for mucin-4. Werner syndrome is due to an autosomal recessive mutation in the WRN gene and predisposes patients to malignancy.Case presentationA 37-year-old Caucasian female presented to the emergency department with 4 months of dyspnea and back pain. She had been treated for pneumonia but had persistent symptoms. A chest, abdomen, and pelvis computed tomography showed near-complete right upper lobe collapse and consolidation, mediastinal lymphadenopathy, lytic spinal lesions, and a single 15-mm hypodense liver nodule. The patient underwent a transthoracic right upper lobe biopsy, bronchoscopy, endobronchial ultrasound with transbronchial lymph node sampling, and bronchoalveolar lavage of the right upper lobe. The bronchoalveolar lavage cytology was positive for malignant cells compatible with poorly differentiated non-small cell carcinoma; however, the cell block materials were insufficient to run immunostains for further investigation of the bronchoalveolar lavage results. Consequently, the patient also underwent a liver biopsy of the liver nodule, which later confirmed a diagnosis of sclerosing epithelioid fibrosarcoma. Next-generation sequencing revealed a variant of unknown significance in the WRN gene. She was subsequently started on doxorubicin.ConclusionSclerosing epithelioid fibrosarcoma is a very rare entity, only cited approximately 100 times in literature to date. Physicians should be aware of this disease entity and consider it in their differential diagnosis. Though pulmonary involvement has been described in the context of sclerosing epithelioid fibrosarcoma, this malignancy may affect many organ systems, warranting extensive investigation. Through our diagnostic workup, we suggest a possible link between sclerosing epithelioid fibrosarcoma and the WRN gene. Further study is needed to advance our understanding of sclerosing epithelioid fibrosarcoma and its clinical associations as it is an exceedingly rare diagnosis.

Flexible bronchoscopy findings and management impact in children with oropharyngeal dysphagia.

Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) are frequently performed in children with known or suspected aspiration, however, the additive value of FB in conjunction with direct laryngoscopy and rigid bronchoscopy (DLB) has not been previously quantified. This study details the common endoscopic/cytological findings and associated management impact of FB and BAL in pediatric Aerodigestive patients undergoing combined airway evaluation (FB and DLB) for oropharyngeal dysphagia. A retrospective chart review was performed in children <3 years of age followed through a large Aerodigestive center undergoing outpatient, combined airway endoscopy for dysphagia. Patient and procedural characteristics, endoscopic and BAL findings, and management metrics were collected and analyzed. A secondary analysis evaluated the association between endoscopic findings and medication changes. Ninety-one procedures (median patient age, 15 months) were identified. All procedures included both FB and DLB, and just over half (52.7%) included esophagogastroduodenoscopy. Common endoscopic findings included bronchitis (73.6%), adenoidal hypertrophy (31.9%), and tracheomalacia (10.8%). BAL cytology frequently identified neutrophilic inflammation (mean 39.6% neutrophils[interquartile range 6.5%-71%)]. Cultured pathogens commonly included Streptococcus viridans (46.6%), Hemophilus influenzae (36.3%), Moraxella catarrhalis (30.1%), and Streptococcus pneumoniae (25.0%). FB and BAL results contributed to clinical decisions in 65 of 91 (71.4%) patients. Endoscopically-diagnosed bronchitis (odds ratio [OR] 7.27, 95% confidence interval [CI] 2.4-21.99) and tracheomalacia (OR 5.79, 95% CI 1.20-27.85) were significantly associated with increased odds of medication adjustments following FB. In pediatric Aerodigestive patients undergoing combined airway evaluation for oropharyngeal dysphagia, FB and BAL are high-yield and clinically impactful procedures.

A Longitudinal Analysis of Equine Asthma Presentation and Response to Treatment Using Lung Function Testing and BAL Cytology Analysis in Combination with Owner Perception.

(1) Background: Equine asthma (EA) is a pervasive and important cause of poor performance and respiratory morbidity in horses. Diagnosis of EA includes an owner complaint, clinical scoring, lung function testing, and cytological analysis of bronchoalveolar lavage (BAL) cytology. There is a paucity of information about the longitudinal course of the disease using these outcome assessments; thus, this study sought to describe and quantify, in horses with more than one visit to a specialty pulmonary clinic in New England, the type and range of clinical presentations with an eventual diagnosis of EA. It also aimed to develop and compare the outcomes of scoring systems for owner complaints and veterinary assessments, document and assess the diagnostic methods used, and evaluate the response of the horses to treatment and time. (2) Methods: This study was a retrospective, cross-sectional, STROBE-compliant observational analysis of equine patients who visited the Tufts Cummings Hospital for Large Animals (HLA) for evaluation of equine asthma (EA) from 1999-2023. The horses were categorized as having mild-moderate (mEA) or severe EA (sEA) using the ACVIM consensus statement guidelines. After excluding those with inadequate documentation or only one visit (n = 936), a total of 76 horses were included in the study. Of the 197 visits, 138 (70.0%) resulted in a diagnosis of mEA and 45 (22.8%) resulted in a diagnosis of sEA. Demographic information, owner complaints, clinical examination and scoring, lung function testing, BAL cytology, and recommendations for environmental remediation and pharmacologic treatment were recorded for all the visits. The data were analyzed for agreement between owner complaints (complaint score, CS) and clinical examination findings (examination score, ES), changes in CS and ES, lung function testing, and BAL cytology over time, with 197 visits recorded. (3) Results: A comparison between the CS and ES showed that the owners were more likely than veterinarians to detect cough, and a decrease in cough was the most common owner observation after treatment. The response to the histamine challenge, used to detect airway hyperreactivity, was significantly improved with treatment or time in the horses with mEA, whereas baseline lung function did not significantly change in mEA or sEA. (4) Conclusions: Owners can be astute observers of clinical signs, especially cough, in EA. Tests of airway hyperreactivity are more successful in detecting changes in mEA than are baseline lung function testing and assessment of BAL cytology.

Serum Allergen-Specific Immunoglobulin E in Cats with Inflammatory Bronchial Disease.

The etiology of feline inflammatory bronchial disease is poorly understood. This study compares the degree of allergen-specific serum IgE responses between cats with feline asthma, chronic bronchitis, mixed inflammation, and clinically healthy cats (HCs). The retrospective case-control study used serum from eighteen cats with eosinophilic inflammation (EI), ten with neutrophilic inflammation (NI), six with mixed inflammation (MI), and fourteen HCs. Affected cats were categorized into groups based on bronchoalveolar lavage cytology. The measurement of IgE for 34 different allergens including fungal organisms, weeds, grasses, trees, mites, and insects was performed using an indirect ELISA. Positive reactions to allergens were detected in the serum of 17/18 cats with EI, 8/10 with NI, 6/6 with MI, and 11/14 HCs (p = 0.364). When overall positive reactions were compared between groups, cats with MI (p = <0.01) had significantly more positive reactions against mite allergens than HCs. Blood eosinophils inversely correlated with the absolute amount of allergen-specific serum IgE expressed in ELISA absorbance units (EAs) (p = 0.014). Sensitization against dust mites seems to be more prevalent in cats with MI. However, positive IgE reactions can be observed in healthy and diseased cats, and, therefore, need to be interpreted in the light of clinical findings and environmental conditions of individual patients.

Bronchoalveolar Lavage Cytology in Severe Equine Asthma: Cytocentrifugated versus Sediment Smear Preparations.

Equine asthma is a common respiratory disease that may affect horses of any age. The diagnosis of severe equine asthma (SEA) (historically referred as recurrent airway obstruction or RAO) is based mainly on the history of the animal and clinical signs, which are further supported by the cytological examination of the bronchoalveolar lavage (BAL). This can also be helpful in monitoring the inflammation of the lower airways in response to environmental management and medication. The cytocentrifugated preparation is usually considered the method of choice for BAL cytological interpretation. The aim of this study was to compare the results in terms of differential cell counts (DCC) in BAL cytology performed on sedimented smears and cytocentrifugated preparations. To carry this out, 48 BAL samples were collected from six horses with SEA that were subjected to a process of exacerbation of the disease by environmental stimuli, which was later followed by the appropriate treatment. Each collected BAL fluid was equally divided into duplicate portions: one processed by cytocentrifugation and one by sediment smear from simple centrifugation. Cytologic examination of all BAL by both methods showed poor concordance in DCC, although it was still able to allow diagnostic recognition of severe lung neutrophilic disorders. These results suggest that sediment smear preparation, although remaining a useful method in general equine practice associated with clinical assessments in the diagnosis of SEA under conditions where there is no possibility of using a cytocentrifuge, cannot be considered a comparable alternative.

Neutrophil gelatinase-associated lipocalin as a potential biomarker for equine asthma.

Studies in people have found neutrophil gelatinase-associated lipocalin (NGAL) concentrations are increased in asthma and can be used to distinguish between asthma subtypes. NGAL has not yet been investigated in equine asthma (EA). To investigate the ability of NGAL concentrations in bronchoalveolar lavage (BAL) fluid and serum to distinguish between control horses, horses with mild-moderate EA (MEA) and horses with severe EA (SEA). Retrospective cross-sectional study. Details of endoscopic examination including tracheal mucus score (TMS, scale 0-5) and BAL cytology performed on 227 horses were extracted from records and NGAL concentrations were measured on stored serum and BAL fluid samples. The horses were divided into groups (control group n = 73, MEA n = 98, SEA n = 56) based on clinical signs and BAL cytology results. Differences between groups were evaluated with the Mann-Whitney test and correlation between BAL NGAL, serum NGAL, and BAL cytology were evaluated using Spearman's correlation. BAL NGAL concentrations were higher in EA than in control horses (median: 25.6 and 13.3 μg/L, respectively, p < 0.001). Concentrations of NGAL in BAL differed between groups, with higher concentrations in MEA than in control horses (median: 18.5 and 13.3 μg/L, respectively, p < 0.001), and higher concentrations in SEA than in MEA horses (median: 54.1 and 18.5 μg/L, respectively, p < 0.001). BAL NGAL concentration differed between horses with TMS ≤2 an >2 (median 15.6 and 21.1 μg/L, respectively, p = 0.004). No differences were found in serum NGAL concentration between any of the groups. Only 66 of the 227 (29%) horses had haematology and serum NGAL measured. BAL NGAL concentration differed between control and EA and reflected severity of disease. These results justify further research into the potential of NGAL as a biomarker of EA.

Bronchoalveolar lavage cytology in children with chronic unexplained cough and severely neurologically impaired children.

We aimed to compare the cellular composition of bronchoalveolar lavage (BAL) fluids in children with chronic unexplained cough (group 1) and severely neurologically impaired children with chronic or recurrent respiratory problems (group 2) with the BAL cytology of children without pulmonary or systemic diseases (group 3). Bronchoscopy with BAL fluid analysis was performed in all subjects. Children with respiratory symptoms underwent 24-hour multichannel intraluminal impedance monitoring. A significant difference was found between the groups in the total number of cells in BAL fluid cytology (191 [range, 24-12,747], 747 [range, 53-13,000], and 105 [range, 41-233] cells/μL, P = .015), in the percentage of neutrophils (21.2 [SD = 32.4], 49.4 [SD = 36.6], and 3.6 [SD = 2.4], P < .001), and in the percentage of lipid-laden macrophages (10.3 [SD = 11.4], 13.7 [SD = 15.8] and 0.44 [SD = 1.0], P < .001). The BAL fluid cytology provides useful data for determining the cause of chronic unexplained cough and chronic or recurrent respiratory problems in severely neurologically impaired children.

Prospective evaluation of the efficacy of inhaled steroids administered via the AeroDawg spacing chamber in management of dogs with chronic cough

Glucocorticoids are frequently required for management of cough because of inflammatory airway disease (IAD) and airway collapse (AWC). To determine the efficacy and feasibility of inhaled administration of corticosteroids in controlling cough in dogs with noninfectious airway disease. Thirty-six client-owned dogs. Dogs were prospectively recruited for this placebo-controlled cross-over study. Inflammatory airway disease was diagnosed through bronchoalveolar lavage cytology. Airway collapse was diagnosed through bronchoscopy, or if dogs were unsuitable anesthetic candidates, by crackles on auscultation, radiographic changes in airway diameter, or fluoroscopy. Dogs were randomly assigned to receive placebo or fluticasone propionate for the first 2 weeks of the trial then crossed over to fluticasone. A quality of life (QOL) survey (best score 0, worst score 85) was completed at 0 and 6 weeks. A visual-analog cough survey was submitted at 0, 2, 4, and 6 weeks to assess cough, feasibility, and adverse effects of treatment. For 32 dogs, QOL score at study end (mean 11.3 ± 9.7) was significantly lower (P < .0001) compared to entry (mean 28.1 ± 14.1), with a median change of 69% in QOL score,indicatingimprovedqualityoflife. Cough frequency, duration, and severity were significantly (P < .0001) decreased at study end. Feasibility of aerosolized delivery improved with continued use (P=.05) with only 1 dog unable to accept inhaled medication. This study supports the utility of fluticasone propionate by inhalation in management of cough in dogs with IAD and AWC.

The cytological diagnosis of Pneumocystis jiroveci pneumonia in bronchoalveolar lavage.

Immunosuppressed individuals are more prone for opportunistic infections. Pneumocystis jiroveci pneumonia (PJP), previously known as Pneumocystis carinii pneumonia (PCP), is the most common opportunistic infection affecting people living with HIV. As PJP can cause life threatening serious infection to a patient, treatment should not be delayed for these cases. To study clinico-cytomorphological spectrum of PJP. We analysed the clinical and detailed cytological features of 15 patients with PJP who were diagnosed on examination of bronchoalveolar lavage (BAL) fluid. The mean age of the patients was 38.4 years (range 13 - 61 years). A total of seven patients were HIV positive; five patients were post renal transplant, and one patient was a known case of acute leukaemia on immunosuppression. Presence of foamy alveolar casts (FACs) was the distinctive feature and was noted in 14 out of 15 cases. We detected 14 out of 15 cases accurately in BAL fluid cytology. BAL cytology is one of the important modes of investigations which can detect PJP infection. The history of fever, cough, immunosuppression, bilateral haziness in the radiography of lung and the characteristic alveolar cast indicate the possibility of PJP infection. Cytology can provide early diagnosis and can reduce the mortality of immunocompromised patients.

Bronchoalveolar Lavage in Diagnostic Evaluation of Pulmonary Diseases- An Institutional Experience.

Bronchoalveolar lavage (BAL) is a widely accepted investigative tool for the diagnosis of pulmonary lesions. This study was done to find out the usefulness of BAL in diagnosis of pulmonary lesions from central Indian patient population. A cross-sectional prospective study was performed over a period of three years. All the BAL specimens of patients presenting to Department of Pulmonary Medicine and Tuberculosis during a period of January 2017 to December 2019 were included in the study. Cyto-histopathologic correlation was done, wherever available. Of total 277 cases, there were 178 (64.5%) males and 99 (35.5%) females. The age of patients ranged from 4 years to 82 years. In 92 (33%) cases, specific infective etiology could be identified on BAL cytology, the most common being tuberculosis (26%) followed by fungal infections (2%). Rarely, infections like nocardia, actinomycosis, and hydatidosis were also identified. Eight cases (3%) of malignancy were identified which included two cases of adenocarcinoma, one case of small cell carcinoma, three cases of poorly differentiated carcinoma, and two cases suspicious for malignancy. Some rare diagnoses like diffuse alveolar damage, pulmonary alveolar microlithiasis, and pulmonary alveolar proteinosis could be identified on BAL. BAL is useful in primary diagnosis of infections and malignancies of lower respiratory tract. BAL may aid in diagnostic workup of diffuse lung diseases. A combination of clinical information, high-resolution computed tomography, and BAL analysis may furnish an assured diagnosis to the clinician and obviate need for invasive procedures.

Role of Bronchoscopic Cytology in Diagnosis of Pulmonary Lesions.

Respiratory cytology specimens such as bronchoalveolar lavage (BAL) and bronchial wash (BW) obtained using a fiberoptic bronchoscope are very useful in detecting or ruling out various inflammatory conditions, infections, and neoplastic lesions. A study was carried out to determine the usefulness of respiratory cytology in the diagnosis of pulmonary lesions and the limitations of cytology if any, and correlate the results of cytology with biopsies wherever possible. All bronchoscopic cytology and biopsy specimens received at the pathology laboratory of this tertiary care institute between June 2014 and May 2017 were analyzed. Cytology smears were stained with Leishman's stain, hematoxylin and eosin (H and E), Papanicolaou (PAP), and Ziehl-Neelsen (ZN) stain for all cases and special stains wherever needed. Slides prepared from biopsy specimens were stained with H and E. Immunohistochemistry was used for confirmation and further typing of malignant lesions and diagnosis rendered was compared with the corresponding cytology diagnosis. A total of 120 specimens of BAL or BW cytology with or without biopsy were analyzed. Thirty-three were diagnosed as non-specific inflammatory lesions. The most common malignancy diagnosed by cytology was adenocarcinoma followed by squamous cell carcinoma. Correlating BAL with biopsy specimens, the sensitivity, specificity, and diagnostic accuracy of BAL were 100%, 88.8%, and 91.6%, respectively. Correlating BW with biopsy specimens, the sensitivity, specificity, and diagnostic accuracy of BW were 85.6%, 85.6%, and 85.6%, respectively. Accurate diagnosis can be made from the examination of bronchoscopic cytology specimens in pulmonary inflammation, tuberculosis, fungal infections, and malignancies. Combining respiratory cytology with biopsy and ancillary techniques can aid in better subtyping of neoplastic lesions.

Diagnostic Yield of Bronchoalveolar Lavage in Nepalese Patients Presenting with Chronic Cough with Normal Radiological Imaging in Tertiary Care Hospital

Background: Cough is one of the most common symptoms that lead patients to seek medical attention. The diagnosis of chronic cough is complex and challenging. In our setting, a large proportion of patients with cough are treated empirically without a definite diagnosis. Despite investigation and treatment, fiberoptic bronchoscope with bronchoalveolar lavage (BAL) has been shown to be a useful technique in a selected group of patients with unexplained chronic persistent cough. The aim of the study was to determine the diagnostic yield of bronchoalveolar lavage in Nepalese patients presenting with chronic cough with normal radiological imaging. Methods: This was a hospital based cross sectional study. The patients presenting with chronic cough (&gt;8 weeks) with normal radiological imaging were enrolled in the study. Results: 1 patient (2.6%) sputum sample for AFB was negative however BAL sample of the same patient sent for Gene xpert came positive for Mycobacterium Tuberculosis, 5 patients (12.8%) had positive BAL culture, 29 patients (74.4%) had normal cellular pattern in BAL Cytology. Conclusion: Diagnostic yield of BAL was very low for chronic cough in our study. Patient presenting with eosinophilic pattern in BAL had cough variant asthma suffer from non-productive cough in the absence of other asthma symptoms such as dyspnea and wheezing. Thus, though fiberoptic bronchoscope with BAL is indicated in chronic cough of unknown etiology, its diagnostic yield is low

The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review.

The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.

Mild-moderate equine asthma: A scoping review of evidence supporting the consensus definition

Current consensus defines mild-moderate equine asthma (mEA; previously inflammatory airway disease) by a hierarchy of indicators of lung pathology: cough, poor performance, increased tracheobronchial mucus, inflammatory bronchoalveolar lavage (BAL) cytology and pulmonary dysfunction. Exclusion criteria include fever, systemic disease, or increased resting respiratory effort. The aim of this review was to inform future research by identifying gaps, strengths and weaknesses in the current body of evidence supporting this consensus-proposed definition. Objectives were to critique evidence supporting the inclusion of each diagnostic indicator in the case definition, by summarising and evaluating evidence for its association with higher-level indicators of lung inflammation. Searches of three databases identified 2275 articles relating to mEA or its diagnostic indicators, from which 298 full-text articles were screened and 45 reviewed in full. Studies (n = 44) had been performed worldwide in clinics, hospitals, racetracks, yards or research herds, in 6092 horses. Studies were predominantly opportunistic observational (n = 13/44: 29.5%) or cross-sectional (n = 11/44; 25%). The median number of horses per study was 74. Where breed and use were reported most were Thoroughbreds (58.2%; 2730/4688) and racehorses (72.8%; n = 3960/5439). Domains rated as high risk of bias in almost 50% of articles were ‘study power’ and ‘masking’. Heterogeneity in clinical and laboratory measures precluded meta-analysis. Evidence was more consistent for certain pairwise relationships (e.g., between cough and tracheobronchial mucus) than others (e.g., BAL cytology and lung function). Findings highlight the need for increased standardisation of diagnostic methods and reporting to facilitate future systematic review and meta-analysis.

Comprehensive Flow Cytometric Characterization of Bronchoalveolar Lavage Cells Indicates Comparable Phenotypes Between Asthmatic and Healthy Horses But Functional Lymphocyte Differences.

Equine asthma (EA) is a highly relevant disease, estimated to affect up to 20% of all horses, and compares to human asthma. The pathogenesis of EA is most likely immune-mediated, yet incompletely understood. To study the immune response in the affected lower airways, mixed leukocytes were acquired through bronchoalveolar lavage (BAL) and the cell populations were analyzed on a single-cell basis by flow cytometry (FC). Samples of 38 horses grouped as respiratory healthy or affected by mild to moderate (mEA) or severe EA (sEA) according to their history, clinical signs, and BAL cytology were analyzed. Using FC, BAL cells and PBMC were comprehensively characterized by cell surface markers ex vivo. An increased percentage of DH24A+ polymorphonuclear cells, and decreased percentages of CD14+ macrophages were detected in BAL from horses with sEA compared to healthy horses or horses with mEA, while lymphocyte proportions were similar between all groups. Independently of EA, macrophages in BAL were CD14+CD16+, which contrasts the majority of CD14+CD16- classical monocytes in PBMC. Percentages of CD16-expressing BAL macrophages were reduced in BAL from horses with sEA compared to healthy horses. While PBMC lymphocytes predominantly contain CD4+ T cells, B cells and few CD8+ T cells, BAL lymphocytes comprised mainly CD8+ T cells, fewer CD4+ T cells and hardly any B cells. These lymphocyte subsets’ distributions were similar between all groups. After PMA/ionomycin stimulation in vitro, lymphocyte activation (CD154 and T helper cell cytokine expression) was analyzed in BAL cells of 26 of the horses and group differences were observed (p=0.01–0.11). Compared to healthy horses’ BAL, CD154+ lymphocytes from horses with mEA, and CD4+IL-17A+ lymphocytes from horses with sEA were increased in frequency. Activated CD4+ T helper cells were more frequent in asthmatics’ (mEA, sEA) compared to healthy horses’ PBMC lymphocytes. In summary, FC analysis of BAL cells identified increased polymorphonuclear cells frequencies in sEA as established, while macrophage percentages were mildly reduced, and lymphocyte populations remained unaffected by EA. Cytokine production differences of BAL lymphocytes from horses with sEA compared to healthy horses’ cells point towards a functional difference, namely increased local type 3 responses in sEA.