Eosinophilic pneumonia other diagnostic studies: Difference between revisions
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* BAL is performed in the majority of patients to quantitate eosinophilia and to exclude infection, hemorrhage, or malignancy (eg, germ cell tumor, leukemia). | * BAL is performed in the majority of patients to quantitate eosinophilia and to exclude infection, hemorrhage, or malignancy (eg, germ cell tumor, leukemia). | ||
* The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots (to evaluate for hemorrhage) in an area of radiographic opacity. Samples are sent for cell count, microbiologic studies, and cytology. | * The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots (to evaluate for hemorrhage) in an area of radiographic opacity. Samples are sent for cell count, microbiologic studies, and cytology. | ||
* In AEP, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils [8,9,36,41,42]. | * In AEP, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils [8,9,36,41,42]. The median BAL cellularity was 350,000 [210,000-775,000] /mm3. BAL eosinophilia was present in all cases, with a median of 38 [32-58] %. | ||
* While data on other cell counts are limited, the proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent [9,14,19,26]. | * While data on other cell counts are limited, the proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent [9,14,19,26]. | ||
* The level of eosinophilia returns to normal when the illness resolves [9,41,42]. | * The level of eosinophilia returns to normal when the illness resolves [9,41,42]. | ||
Revision as of 20:09, 9 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other diagnostic studies
Bronchoscopy with bronchoalveolar lavage
- BAL is performed in the majority of patients to quantitate eosinophilia and to exclude infection, hemorrhage, or malignancy (eg, germ cell tumor, leukemia).
- The BAL is performed using a sequential instillation and recovery of 50 to 60 mL aliquots (to evaluate for hemorrhage) in an area of radiographic opacity. Samples are sent for cell count, microbiologic studies, and cytology.
- In AEP, the BAL fluid typically shows a very high proportion (>25 percent) and total number of eosinophils [8,9,36,41,42]. The median BAL cellularity was 350,000 [210,000-775,000] /mm3. BAL eosinophilia was present in all cases, with a median of 38 [32-58] %.
- While data on other cell counts are limited, the proportion of BAL lymphocytes is approximately 10 to 30 percent and the proportion of BAL neutrophils is 1 to 16 percent [9,14,19,26].
- The level of eosinophilia returns to normal when the illness resolves [9,41,42].
Lung biopsy
- Lung biopsy is rarely necessary to make a diagnosis of AEP in immunocompetent patients with a compatible history and prominent BAL eosinophilia in the absence of infection or other known precipitant [7,8,62].
- Indications for lung biopsy would include concern about an infectious etiology that could not be quickly excluded by BAL or failure to respond to systemic glucocorticoids.