Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Upper and middle lobe bronchoalveolar lavage to diagnose Pneumocystis carinii pneumonia [see comments]
Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1563-6. Unique Identifier : AIDSLINE MED/94079096 Yung RC; Weinacker AB; Steiger DJ; Miller TR; Stern EJ; Salmon CJ; Chernoff DN; Luistro MG; Kuntz S; Golden JA; Department of Medicine, University of California at San Francisco; 94143-0854.
Abstract:
Pneumocystis carinii pneumonia (PCP) remains the most common lethal opportunistic pulmonary infection in patients infected with the human immunodeficiency virus (HIV). Although the use of prophylactic inhaled pentamidine has effectively reduced the frequency of primary and recurrent episodes of PCP, the aerosolization of pentamidine may have altered the localization of active PCP, resulting in more upper lobe disease. The distribution of disease may have also affected the diagnostic accuracy of standard bronchoalveolar lavage of the middle lobe, with a reduction in sensitivity from about 90 to 65%. In retrospective surveys of patients from our institution, Steiger and Fahy found that pooled multiple-lobe radiographic site-directed bronchoalveolar lavage resulted in diagnostic sensitivities of 91 and 100%, respectively. We performed a follow-up prospective study of 38 consecutive patients on aerosolized pentamidine in whom we lavaged both the middle lobe and an upper lobe. We found that bilobar lavage including routine lavage of an upper lobe increases the diagnostic sensitivity of bronchoalveolar lavage alone to 95% compared with 65% if lavage is performed only in the middle lobe (p < 0.05). Radiographic studies demonstrate a concordant increase in exclusive or predominant upper lobe disease in patients on aerosolized pentamidine, but our results indicate that PCP is recovered more frequently from the upper lobe regardless of the radiographic appearance. We conclude that all patients on prophylactic inhaled pentamidine should undergo bilobar lavage with the inclusion of an upper lobe in the initial evaluation of possible PCP. The diagnostic sensitivity of 95% makes bilobar bronchoalveolar lavage an acceptable sole initial diagnostic modality without the need for initial transbronchial lung biopsy.
Keywords: AIDS-Related Opportunistic Infections/*DIAGNOSIS/RADIOGRAPHY *Bronchoalveolar Lavage Fluid Human Lung/RADIOGRAPHY Pneumonia, Pneumocystis carinii/*DIAGNOSIS/RADIOGRAPHY Prospective Studies Sensitivity and Specificity JOURNAL ARTICLE Comment in: Am J Respir Crit Care Med 1995 Jan;151(1):253-4
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M9430554
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
