Bronchoalveolar lavage
The bronchoalveolar lavage ( BAL ; from Latin: bronchus "bronchie", alveolus "pulmonary alveoli " and lavars "wash") and the technically different bronchial lavage are diagnostic and therapeutic procedures in medicine. The latter is also - rather historically - referred to in English as tracheal wash (" tracheal flushing "). These procedures are used to remove mucus, including the removal of mucus plugs, and cytological samples from the lungs as part of a bronchoscopy .
execution
The bronchoalveolar lavage is carried out deep into the lungs, the alveoli , and is used for cytological and immunohistochemical examinations.
Bronchial lavage, on the other hand, is carried out in the trachea and bronchi and helps with bacteriological examinations , mechanical cleaning or cytological examinations. It is often combined with brush swabs as part of the collection of cells, as well as with sampling with fine forceps.
There are combined forms in which irrigation fluid is used in various amounts, up to many liters, for therapeutic secretion removal, for example in alveolar proteinosis .
In humans, Ringer's solution or 0.9% saline solution is usually given into the lungs and then sucked off again. The aspirated solution contains the mucus with flushed out cells of the respiratory epithelium and immune system as well as possibly bacteria and other pathogens.
Examination of the material
The material obtained in this way can be examined cytologically in order to diagnose bronchial carcinoma , for example , or it can be subjected to a bacteriological examination to determine the specific pathogen. Furthermore, indications of organ involvement in the context of autoimmune diseases (e.g. sarcoid , alveolitis or systemic scleroderma ) can be made. For this purpose, special cytological patterns of the immune cells obtained (especially leukocytes ) point the way.
Risks
After the BAL, complications occur in up to 2.3% of cases, but these are not serious. After the examination, fever, constriction of the bronchi, a reversible (reversible) decrease in lung function parameters or reversible inflammatory infiltrates of lung segments can occur. Post-bleeding may also occur in patients with an increased tendency to bleed.
literature
- Joachim Lorenz: Checklist Pneumology. Thieme 1998, ISBN 3-13-115071-8 .
- Dietrich Nolte: Asthma: the clinical picture, the asthma patient, the therapy. Urban & Schwarzenberg, 1995, ISBN 3-541-09356-0 .
Web links
Individual evidence
- ↑ M. Tötsch, J. Guzman, D. Theegarten, KW Schmid, U. Costabel: Bronchoalveolar Lavage. In: Pathologist. 28 (5), Sep 2007, pp. 346-353. PMID 17661044
