Indications

Diagnostic

Diagnosis of Endobronchial Airway Lesion (see Obstructive Lung Disease)

• xxxxx

Diagnosis of Hilar/Mediastinal Lymphadenopathy

• Endobronchial Ultrasound-Transbronchial Needle Aspiration (EBUS-TBNA)

Diagnosis of Pneumonia in Immunocompromised Host

• Clinical Efficacy
  • Study of the Utility of Bronchoscopy with Bronchoalveolar Lavage in the Immunocompromised Host with Pulmonary Infiltrates (BMC Pulm Med. 2019 [MEDLINE]
    • A total of 217 patients were recruited (70.1% male and mean age: 51.7 ± 14.6 years)
    • Diagnostic yield was 60.8% and complication rate 14.7%
    • Complications (hypoxemia and endobronchial bleeding) were all sell-limiting
    • Treatment modification based on BAL results was 63.3%. In 97.0% an infectious aetiology was identified
    • HIV infection (OR 5.304, 95% CI 1.611–17.458, p = 0.006) and severe neutropenia (OR 4.253, 95% CI 1.288–14.045, p = 0. 018) were associated with positive yield. Leukemia (OR 0.317, 95% CI 0.102–0.982, p = 0.047) was associated with lower yield
    • No factors impacted complication rate
    • Overall mortality (90-day) was 17.5% and in those with hematologic malignancy, it was 28.3%

Diagnosis of Source of Hemoptysis (see Hemoptysis)

• xxxxx

Diagnosis of Vocal Cord Abnormality (see Obstructive Lung Disease)

• xxxx

Therapeutic

Clearance of Mucous Plugging Contributing to Atelectasis (see Atelectasis)

• Observational Study of Use of Bronchoscopy in Mechanically-Ventilated Patients (Using Data from the National Inpatient Sample, NIS) (Chest, 2022)[MEDLINE]: NIS sample set included 97% of all hospitalizations in the United States
  • We identified 6,101,070 invasive mechanical ventilation-treated hospitalizations (2012-2018), of which 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were female, and in-hospital mortality was 30.8%
  • The percentage of IMV hospitalizations receiving bronchoscopy increased from 9.5% (95% CI: 9.1, 9.9) in 2012 to 10.8% (95% CI: 10.4, 11.2) in 2018, p<0.001 for difference
  • In 2018, bronchoscopy use varied from 0% to 57.1% among 1787 hospitals, and in multi-level models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level
  • The median odds ratio (MOR) was 2.13 (95%CI: 2.05, 2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower use to a higher use hospital

Clearance of Blood Clots Associated with Hemoptysis (see Hemoptysis)

• xxxx

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Technique

Bronchoscopy Requires Procedural Sedation (see Sedation)

• xxxxx

Bronchoalveolar Lavage (BAL)

• Instillation: total instilled volume of normal saline should be no less than 100 ml and should not exceed 300 ml (Am J Respir Crit Care Med, 2012)[MEDLINE]
• Return: although return on bronchoalveolar lavage is quite variable (usually 40-60% of volume instilled

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Bronchoalveolar Lavage (BAL)

Normal Bronchoalveolar Lavage (BAL) Cellular Patterns (Non-Smokers) (Am J Respir Crit Care Med, 2012) [MEDLINE]

• Alveolar Macrophages: >85%
• Lymphocytes: 10-15%
  • CD4/CD8 Ratio: 0.9-2.5
• Neutrophils: ≤3%
• Eosinophils: ≤1%
• Squamous Epithelial/Ciliated Columnar Epithelial Cells: ≤5%
  • Presence of >5% Squamous Epithelial Cells Indicates Upper Airway Secretion Contamination and that the Sample is Suboptimal
    • Therefore, the Bronchoalveolar Lavage Cellular Pattern Should Be Interpreted with Caution

Need for Bronchoalveolar Lavage (BAL) Cellular Analysis Based on Appearance of HRCT (Am J Respir Crit Care Med, 2012) [MEDLINE]

• HRCT with Extensive Honeycombing: BAL cellular analysis is not required
• HRCT with Diagnostic Pattern: BAL cellular analysis is not required
• HRCT with Non-Diagnostic Pattern: BAL cellular analysis is recommended

Etiology of Bronchoalveolar Lavage (BAL) Lymphocytosis (>15%) (Am J Respir Crit Care Med, 2012) [MEDLINE]

Bronchoalveolar Lavage Lymphocytosis >15%

• Collagen Vascular Disease
• Cryptogenic Organizing Pneumonia (COP) (see Cryptogenic Organizing Pneumonia)
• Drug-induced Pneumonitis
• Granulomatous Lung Disease
  • Chronic Berylliosis (see Beryllium)
  • Hypersensitivity Pneumonitis (HP) (see Hypersensitivity Pneumonitis)
    • Low CD4/CD8 Ratio Occurs Due to a Relative Increase in CD8 Cells
    • Differential with >50% Lymphocytes + >3% Neutrophils + >1% Mast Cells is Suggestive of Acute Hypersensitivity Pneumonitis
  • Sarcoidosis (see Sarcoidosis): lymphocytosis >35% may be seen
    • High CD4/CD8 Ratio >3.5: CD41/CD81 >4 is highly specific for sarcoidosis in the absence of an increased proportion of other inflammatory cell types
• Lymphocytic Interstitial Pneumonitis (LIP) (see Lymphocytic Interstitial Pneumonia)
• Lymphoproliferative Disorder
  • Lymphoma (see Lymphoma)
• Non-Specific Interstitial Pneumonia (NSIP) (see Non-Specific Interstitial Pneumonia)
• Radiation Pneumonitis (see Radiation Pneumonitis and Fibrosis)
• Tuberculosis (see Tuberculosis)

Bronchoalveolar Lavage Lymphocytosis ≥25%

• Cryptogenic Organizing Pneumonia (COP) (see Cryptogenic Organizing Pneumonia)
• Drug-Induced Pneumonitis
• Granulomatous Lung Disease
  • Chronic Berylliosis (see Beryllium)
  • Common Variable Immunodeficiency (CVID)-Associated Granulomatous-Lymphocytic Interstitial Lung Disease (see Common Variable Immunodeficiency)
  • Hypersensitivity Pneumonitis (HP) (see Hypersensitivity Pneumonitis)
    • Low CD4/CD8 Ratio Occurs Due to a Relative Increase in CD8 Cells
    • Differential with >50% Lymphocytes + >3% Neutrophils + >1% Mast Cells is Suggestive of Acute Hypersensitivity Pneumonitis
  • Sarcoidosis (see Sarcoidosis): lymphocytosis >35% may be seen
    • High CD4/CD8 Ratio >3.5: CD41/CD81 >4 is highly specific for sarcoidosis in the absence of an increased proportion of other inflammatory cell types
• Lymphocytic Interstitial Pneumonia (LIP) (see Lymphocytic Interstitial Pneumonia)
• Lymphoproliferative Disorder
  • Lymphoma (see Lymphoma)
• Non-Specific Interstitial Pneumonia (NSIP) (see Non-Specific Interstitial Pneumonia)

Bronchoalveolar Lavage Lymphocytosis >50%

• Non-Specific Interstitial Pneumonia (NSIP) (see Non-Specific Interstitial Pneumonia)
• Hypersensitivity Pneumonitis (HP) (see Hypersensitivity Pneumonitis)
  • Low CD4/CD8 Ratio Occurs Due to a Relative Increase in CD8 Cells
  • Differential with >50% Lymphocytes + >3% Neutrophils + >1% Mast Cells is Suggestive of Acute Hypersensitivity Pneumonitis

Etiology of Bronchoalveolar Lavage (BAL) Neutrophilia (>3%) (Am J Respir Crit Care Med, 2012) [MEDLINE]

• Acute Bronchitis (see Acute Bronchitis)
• Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome): BAL neutrophilia may be >50%
• Asbestosis (see Asbestos)
• Aspiration Pneumonia (see Aspiration Pneumonia): BAL neutrophilia may be >50%
• Collagen Vascular Disease
• Diffuse Alveolar Damage (DAD)
  • Acute Interstitial Pneumonia (AIP)
  • Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome)
  • Connective Tissue Disease
  • Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis)
  • Radiation Therapy/Radiation Pneumonitis (see Radiation Therapy and Radiation Pneumonitis and Fibrosis)
  • Toxic Inhalation
    • Heavy Metal Fumes
      • Cadmium (see Cadmium)
      • Mercury (see Mercury)
      • Nickel Carbonyl (see Nickel Carbonyl)
    • Ozone (see Ozone)
    • Smoke Inhalation (see Smoke Inhalation)
• Electronic Cigarette/Vaping-Associated Lung Injury (EVALI) (see Electronic Cigarette/Vaping-Associated Lung Injury)
  • Bronchoalveolar Lavage Fluid Neutrophils Have Been Reported to Be 58% (Range: 10-91%) (NEJM, 2020) [MEDLINE]
  • Bronchoalveolar Lavage Fluid Eosinophilia Has Also Been Reported in Some Cases (J Emerg Med, 2014) [MEDLINE]
  • Presence of Lipid Laden-Macrophages (Positive Oil-Red-O Stain) is Common (But This is a Nonspecific Finding) (NEJM, 2020) [MEDLINE]
• Hypersensitivity Pneumonitis (HP) (see Hypersensitivity Pneumonitis)
  • Low CD4/CD8 Ratio Occurs Due to a Relative Increase in CD8 Cells
  • Differential with >50% Lymphocytes + >3% Neutrophils + >1% Mast Cells is Suggestive of Acute Hypersensitivity Pneumonitis
• Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis)
• Infection: BAL neutrophilia may be >50%
  • Bacterial Pneumonia
  • Fungal Pneumonia

Etiology of Bronchoalveolar Lavage (BAL) Eosinophilia (>1%) (Am J Respir Crit Care Med, 2012) [MEDLINE]

General Comments

• Although Pathologic Examination of the Lung is the Gold Standard for Diagnosing Eosinophilic Pneumonia, BAL is a Widely-Accepted Noninvasive Surrogate of Lung Biopsy for Diagnosis in Patients with High-Resolution Features of Eosinophilic Pneumonia
  • However, No Study Has Definitely Established a Correlation Between the Presence of BAL Eosinophilia and the Finding of Eosinophilic Pneumonia on Lung Pathology
• BAL Eosinophil Percentage in Various Disease States
  • Normal: BAL eosinophil <1%
  • BAL Eosinophilia 3-40% (and Especially Between 3-9%): may be found in various disorders
  • BAL Eosinophilia >40%: found predominantly in patients with chronic eosinophilic pneumonia
• BAL Eosinophil Percentage Proposed Cut-Off Values
  • Diagnosis of Idiopathic Acute Eosinophilic Pneumonia: BAL Eosinophilia >25%
  • Diagnosis of Idiopathic Chronic Eosinophilic Pneumonia: BAL Eosinophilia >40%

Eosinophilic Pulmonary Syndromes of Known Etiology

Parasitic Infection

• General Comments: parasite-associated eosinophilic pneumonias represent the most common etiologies of pulmonary infiltrates with eosinophilia worldwide
• Capillaria Aerophila (see Capillariasis)
  • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
• Clonorchis Sinensis (see Clonorchiasis)
  • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
• Dirofilariasis (see Dirofilariasis)
  • Clinical: eosinophilic pulmonary infiltrates
• Echinococcosis (see Echinococcosis)
• Paragonimiasis (see Paragonimiasis)
  • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
• Schistosomiasis (see Schistosomiasis): the manifestations of schistosomiasis in the lung vary dependent on the stage of disease
  • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
  • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
  • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
• Simple Pulmonary Eosinophilia (Loffler Syndrome) (see Simple Pulmonary Eosinophilia)
  • Ascaris Lumbricoides (or Ascaris Suum): most common etiology of simple pulmonary eosinophilia (Loffler syndrome)
  • Necator Americanus
  • Ancylostoma Duodenale
  • Ancylostoma Brazliense or Canium
  • Entamoeba Histolytica
  • Fasciola Hepatica
  • Schistosomiasis (see Schistosomiasis): the manifestations of schistosomiasis in the lung vary dependent on the stage of disease
    • Early Acute Schistosomiasis: transient, multiple small pulmonary nodules with peripheral eosinophilia
    • Chronic Schistosomiasis: embolization of ova in small arteries of the lung results in granuloma formation, occlusion and remodeling of pulmonary arteries, and further pulmonary hypertension mediared by portopulmonary hypertension
    • Post-Treatment of Schistosomiasis: eosinophilic pneumonitis (lung shift, verminous pneumonia, reactionary Loffler-like pneumonitis) due to antigen release following treatment
  • Strongyloides Stercoralis: simple pulmonary eosinophilia (Loffler syndrome) may occur when larvae migrate through the lungs after acute infection
• Strongyloides Stercoralis Hyperinfection Syndrome (see Strongyloidiasis)
  • Epidemiology: occurs in 20% of patients hospitalized with strongyloidiasis and coexisting chronic lung disease (COPD, asthma)
  • Diagnosis: rhabditiform larvae may be recovered via bronchoalveolar lavage, bronchial wash, or sputum sample
  • Clinical: cough/wheezing/dyspnea with bilateral patchy infiltrates and variable degree of eosinophilia
• Trichinosis (see Trichinosis)
  • Epidemiology: rare etiology of eosinophilic pulmonary infiltrates
• Tropical Pulmonary Eosinophilia (Occult Filariasis) (see Tropical Pulmonary Eosinophilia)
  • Wuchereria Bancrofti
  • Brugia Malayi
  • Brugia Timori
• Visceral Larva Migrans (see Visceral Larva Migrans)
  • Toxocara Canis

Other Infection

• Aspergillus Niger (see Aspergillus)
  • Epidemiology: case reports of eosinophilic pneumonia
• Bipolaris Australiensis
  • Epidemiology: case reports of eosinophilic pneumonia
• Bipolaris Spicera
  • Epidemiology: case reports of eosinophilic pneumonia
• Brucellosis (see Brucellosis)
  • Epidemiology: case reports of eosinophilic pneumonia [Eosinophilia and pneumonitis in chronic brucellosis: a report of two cases. Ann Intern Med. 1942;16:995-1001]
• Coccidioidomycosis (see Coccidioidomycosis)
  • Clinical: pronounced peripheral eosinophilia may be an early indicator of dissemination
• Cryptococcosis (see Cryptococcosis)
  • Epidemiology: case reports of eosinophilic pneumonia (South Med J, 1995) [MEDLINE]
• Histoplasmosis (see Histoplasmosis)
• Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus)
• Influenza Virus (see Influenza Virus)
  • Epidemiology: may produce eosinophilic pneumonia in some cases
• Mycobacterium Simiae (see Mycobacterium Simiae)
  • Epidemiology: case reports of eosinophilic pneumonia (NEJM, 1989) [MEDLINE]
• Pneumocystis Jirovecii (see Pneumocystis Jirovecii)
  • Epidemiology: BAL eosinophilia has been reported in HIV-associated cases
• Respiratory Syncytial Virus (RSV) (see Respiratory Syncytial Virus)
  • Epidemiology: may produce eosinophilic pneumonia in some cases
• Tuberculosis (see Tuberculosis)
  • Epidemiology: may produce eosinophilic pneumonia in some cases

Allergic Bronchopulmonary Aspergillosis and Related Syndromes

• Allergic Bronchopulmonary Aspergillosis (ABPA) (see Allergic Bronchopulmonary Aspergillosis)
• Allergic Bronchopulmonary Candidiasis (see Candida)
• Bronchocentric Granulomatosis (BCG) (see Bronchocentric Granulomatosis)

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia)

• More Than 80 Drugs/Toxins Have Been Reported to Cause Drug-Induced Pulmonary Eosinophilia

Other

• Breast Radiation-Associated Eosinophilic Pneumonia (see Radiation Therapy)
  • Clinical: chronic eosinophilic pneumonia
• Eosinophilia-Myalgia Syndrome (see Eosinophilia-Myalgia Syndrome)
  • Physiology: due to contaminated L-tryptophan (see L-Tryptophan)
• Toxic Rapeseed Oil Syndrome (see Contaminated Rapeseed Oil)
  • Physiology: due to contaminated rapeseed oil

Eosinophilic Pulmonary Syndromes of Unknown Etiology

• Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome) (see Eosinophilic Granulomatosis with Polyangiitis)
• Hypereosinophilic Syndrome (see Hypereosinophilic Syndrome)
• Idiopathic Acute Eosinophilic Pneumonia (IAEP) (see Acute Eosinophilic Pneumonia)
• Idiopathic Chronic Eosinophilic Pneumonia (ICEP) (see Chronic Eosinophilic Pneumonia)
• Idiopathic Hypereosinophilic Obliterative Bronchiolitis (see Idiopathic Hypereosinophilic Obliterative Bronchiolitis)

Other Pulmonary Disorders with Possible Associated Pulmonary Eosinophilia

• Asthma (see Asthma)
• Electronic Cigarette/Vaping-Associated Lung Injury (EVALI) (see Electronic Cigarette/Vaping-Associated Lung Injury)
  • Bronchoalveolar Lavage Fluid Neutrophils Have Been Reported to Be 58% (Range: 10-91%) (NEJM, 2020) [MEDLINE]
  • Bronchoalveolar Lavage Fluid Eosinophilia Has Also Been Reported in Some Cases (J Emerg Med, 2014) [MEDLINE]
  • Presence of Lipid Laden-Macrophages (Positive Oil-Red-O Stain) is Common (But This is a Nonspecific Finding) (NEJM, 2020) [MEDLINE]
• Eosinophilic Bronchitis (see Eosinophilic Bronchitis)
  • Clinical: chronic cough with sputum eosinophilia (about 40%)
    • Normal Lung Function with Absence of Bronchial Hyperreactivity: although it may evolve over time into either fixed airflow obstruction without asthma or into true asthma
    • Absence of Eosinophilic Pneumonia
• Gastric Cancer with Tumor-Related Production of GM-CSF and IL-5 (see Gastric Cancer)
  • Epidemiology: case report
• Hematopoietic Stem Cell Transplant (HSCT) (Bone Marrow Transplant, BMT) (see Hematopoietic Stem Cell Transplant)
  • Epidemiology: xxxx
• Hodgkin’s Disease (see Hodgkins Disease)
  • Epidemiology: xxxx
• Idiopathic Interstitial Pneumonias
  • Desquamative Interstitial Pneumonia (DIP): mild BAL eosinophilia may occur in some cases
  • Non-Specific Interstitial Pneumonia (NSIP): mild BAL eosinophilia may occur in some cases
• Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis): mild BAL eosinophilia may occur in some cases
• Langerhans Cell Histiocytosis (LCH) (see Langerhans Cell Histiocytosis)
  • Diagnosis: pulmonary pathologic lesions are nodules (with bronchiolocentric stellate shape) with Langerhans cells and variable numbers of eosinophils, plasma cells, and lymphocytes
    • Eosinophils are Usually Present in the Initial, Active Stage of the Disease: they contribute to the eosinophilic granuloma
    • Eosinophils are Numerous in 25% of Cases: usually located at the periphery of the lesions
    • Eosinophils are Rare or Absent at the Chronic Stage of the Disease
• Lung Transplant (see Lung Transplant, [[Lung Transplant]])
  • Acute Lung Transplant Rejection (Acute Cellular Lung Transplant Rejection) (see Acute Lung Transplant Rejection): peripheral eosinophilia may occur with/without pulmonary infiltrates (as acute rejection may be detected by surveillance bronchoscopy with transbronchial biopsy prior to the development of pulmonary infiltrates)
• Organizing Pneumonia (see Cryptogenic Organizing Pneumonia)
  • Diagnosis: mild BAL eosinophilia may occur in some cases (usually <20%)
• Sarcoidosis (see Sarcoidosis)
  • Diagnosis: peripheral eosinophilia (and tissue eosinophilia) may be present, but are usually mild

Etiology of Bronchoalveolar Lavage (BAL) with Hemosiderin-Laden Macrophages (>20%)

• Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage)

Etiology of Bronchoalveolar Lavage (BAL) with Lipid-Laden Macrophages

• Electronic Cigarette/Vaping-Associated Lung Injury (EVALI) (see Electronic Cigarette/Vaping-Associated Lung Injury)
  • Bronchoalveolar Lavage Fluid Neutrophils Have Been Reported to Be 58% (Range: 10-91%) (NEJM, 2020) [MEDLINE]
  • Bronchoalveolar Lavage Fluid Eosinophilia Has Also Been Reported in Some Cases (J Emerg Med, 2014) [MEDLINE]
  • Presence of Lipid Laden-Macrophages (Positive Oil-Red-O Stain) is Common (But This is a Nonspecific Finding) (NEJM, 2020) [MEDLINE]

Other Abnormal Bronchoalveolar Lavage (BAL) Findings (Am J Respir Crit Care Med, 2012) [MEDLINE]

• Infectious Organism: indicates presence of lower respiratory infection
• Malignant Cells (by Light Microscopy or Flow Cytometry): indicates cancer
• Bloody BAL Fluid in Successive Aliquots: indicates pulmonary hemorrhage (with/without diffuse alveolar hemorrhage)
• Milky Fluid with Positive Periodic Acid Schiff (PAS-Positive) Staining and Amorphous Debris: indicates pulmonary alveolar proteinosis
• In Vitro Lymphocyte Proliferative Response to Specific Beryllium Antigen: indicates chronic beryllium disease

Recommendations for Bronchoalveolar Lavage (BAL) in the Setting of Interstitial Lung Disease (Am J Respir Crit Care Med, 2012) [MEDLINE]

• For Patients with Suspected Interstitial Lung Disease in Whom a Bronchoalveolar Lavage Can Be Tolerated, BAL Target Site Be Chosen on the Basis of an HRCT Performed Before the Procedure, Rather than Choosing a Traditional Bronchoalveolar Lavage Site (Such as the Right Middle Lobe or Lingula)
  • HRCT Should Be Performed within 6 wks of the BAL
• For Patients with Suspected Interstitial Lung Disease Who Undergo Bronchoalveolar Lavage, a Differential Cell Count Should Be Performed on the Bronchoalveolar Lavage Fluid
  • Including Lymphocyte, Neutrophil, Eosinophil, and Mast Cell Counts
  • Remaining Sample Should Be Used for Microbiological, Virological, and/or Malignant Cell Cytology Laboratory Testing, if Indicated
• For Patients with Suspected Interstitial Lung Disease Who Undergo Bronchoalveolar Lavage, Lymphocyte Subset Analysis Should Not Be a Routine Component of Bronchoalveolar Lavage Cellular Analysis

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Complications of Bronchoscopy (Respirology, 2012) [MEDLINE]

Complication Rate by Pulmonary Lesion

• General Comments
  • Overall Complication Rate: 0.51%-2.06% (with highest rates being reported for diffuse pulmonary lesions)
  • Complication Rate by Procedure: 0.17%-1.93% (with highest rates being reported for forceps biopsy)
  • Bronchoscope/Device Breakage: reported in 47.2% of centers
    • Patient Biting of Bronchoscope
    • Needle Perforation of Forceps Channel
    • Heat Damage to Bronchscope (During Laser, etc)
    • Malfunction of Biospy Forceps
    • Curette Breakage
• Airway Perforation
  • Reported Frequency (with central airway lesions): 0%
  • Reported Frequency (with hilar/mediastinal lesions): 0%
  • Reported Frequency (with solitary pulmonary lesions): 0%
  • Reported Frequency (with diffuse pulmonary lesions): 0%
• Cardiovascular Event: arrhythmias, myocardial infarction, etc
  • Reported Frequency (with central airway lesions): 0.05%
  • Reported Frequency (with hilar/mediastinal lesions): 0%
  • Reported Frequency (with solitary pulmonary lesions): 0.08%
  • Reported Frequency (with diffuse pulmonary lesions): 0.04%
• Bronchospasm (see Obstructive Lung Disease)
  • Reported Frequency (with central airway lesions): 0.09%
  • Reported Frequency (with hilar/mediastinal lesions): 0.02%
  • Reported Frequency (with solitary pulmonary lesions): 0.06%
  • Reported Frequency (with diffuse pulmonary lesions): 0.08%
• Central Airway Obstruction
• Death
  • Reported Frequency: 0.004%
• Hemorrhage
  • Reported Frequency (with central airway lesions): 0.89%
  • Reported Frequency (with hilar/mediastinal lesions): 0.30%
  • Reported Frequency (with solitary pulmonary lesions): 0.63%
  • Reported Frequency (with diffuse pulmonary lesions): 0.44%
• Infection (see xxxx)
  • Reported Frequency (with central airway lesions): 0.15%
  • Reported Frequency (with hilar/mediastinal lesions): 0.15%
  • Reported Frequency (with solitary pulmonary lesions): 0.25%
  • Reported Frequency (with diffuse pulmonary lesions): 0.21%
• Lidocaine Toxicity
  • Reported Frequency (with central airway lesion): 0.03%
  • Reported Frequency (with hilar/mediastinal lesions): 0.02%
  • Reported Frequency (with solitary pulmonary lesions): 0.04%
  • Reported Frequency (with diffuse pulmonary lesions): 0.05%
• Pneumothorax (see Pneumothorax, [[Pneumothorax]])
  • Reported Frequency (with central airway lesions): 0.004%
  • Reported Frequency (with hilar/mediastinal lesions): 0%
  • Reported Frequency (with solitary pulmonary lesions): 0.44%
  • Reported Frequency (with diffuse pulmonary lesions): 0.87%
• Respiratory Failure (see Respiratory Failure, [[Respiratory Failure]])
  • Reported Frequency (with central airway lesions): 0.03%
  • Reported Frequency (with hilar/mediastinal lesions): 0.02%
  • Reported Frequency (with solitary pulmonary lesions): 0.04%
  • Reported Frequency (with diffuse pulmonary lesions): 0.36%

Complication Rate by Procedure

• Hemorrhage
  • Reported Frequency (with simple bronchoscopy): 0.14%
  • Reported Frequency (with forceps biopsy): 0.85%
  • Reported Frequency (with brush biopsy): 0.25%
  • Reported Frequency (with bronchoalveolar lavage): 0.02%
  • Reported Frequency (with transbronchial needle aspiration): 0.28%
  • Reported Frequency (with EBUS-TBNA of hilar/mediastinal lesions): 0.71%
• Pneumothorax (see Pneumothorax, [[Pneumothorax]])
  • Reported Frequency (with simple bronchoscopy): 0.05%
  • Reported Frequency (with forceps biopsy): 0.67%
  • Reported Frequency (with brush biopsy): 0.03%
  • Reported Frequency (with bronchoalveolar lavage): 0.008%
  • Reported Frequency (with transbronchial needle aspiration): 0.07%
  • Reported Frequency (with EBUS-TBNA of hilar/mediastinal lesions): 1.52%

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References

General

• The BAL Cooperative Group Steering Committee. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis. 1990;141(5 pt 2):S169-S202
• Deaths and complications associated with respiratory endoscopy: a survey by the Japan Society for Respiratory Endoscopy in 2010. Respirology. 2012 Apr;17(3):478-85. doi: 10.1111/j.1440-1843.2011.02123.x [MEDLINE]
• An Official American Thoracic Society Clinical Practice Guideline: The Clinical Utility of Bronchoalveolar Lavage Cellular Analysis in Interstitial Lung Disease. Am J Respir Crit Care Med. 2012 May 1;185(9):1004-14. doi: 10.1164/rccm.201202-0320ST [MEDLINE]

Indications

• Utility of bronchoalveolar lavage in the management of immunocompromised patients presenting with lung infiltrates. BMC Pulm Med. 2019 Feb 26;19(1):51. doi: 10.1186/s12890-019-0801-2 [MEDLINE]
• Temporal trends and variation in bronchoscopy use for acute respiratory failure in the US. Chest. 2022 Aug 22;S0012-3692(22)03654-6. doi: 10.1016/j.chest.2022.08.2210 [MEDLINE]

Bronchoalveolar Lavage (BAL)

• Case report of electronic cigarettes possibly associated with eosinophilic pneumonitis in a previously healthy active-duty sailor. J Emerg Med. 2014;47(1):15 [MEDLINE]
• Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Final Report. N Engl J Med. 2020;382(10):903 [MEDLINE]