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Upper and middle lobe bronchoalveolar lavage to diagnose Pneumocystis carinii pneumonia.
Am Rev Respir Dis. 1993 Dec; 148(6 Pt 1):1563-6.AR

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.

Authors+Show Affiliations

Department of Medicine, University of California at San Francisco 94143-0854.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8256901

Citation

Yung, R C., et al. "Upper and Middle Lobe Bronchoalveolar Lavage to Diagnose Pneumocystis Carinii Pneumonia." The American Review of Respiratory Disease, vol. 148, no. 6 Pt 1, 1993, pp. 1563-6.
Yung RC, Weinacker AB, Steiger DJ, et al. Upper and middle lobe bronchoalveolar lavage to diagnose Pneumocystis carinii pneumonia. Am Rev Respir Dis. 1993;148(6 Pt 1):1563-6.
Yung, R. C., Weinacker, A. B., Steiger, D. J., Miller, T. R., Stern, E. J., Salmon, C. J., Chernoff, D. N., Luistro, M. G., Kuntz, S., & Golden, J. A. (1993). Upper and middle lobe bronchoalveolar lavage to diagnose Pneumocystis carinii pneumonia. The American Review of Respiratory Disease, 148(6 Pt 1), 1563-6.
Yung RC, et al. Upper and Middle Lobe Bronchoalveolar Lavage to Diagnose Pneumocystis Carinii Pneumonia. Am Rev Respir Dis. 1993;148(6 Pt 1):1563-6. PubMed PMID: 8256901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upper and middle lobe bronchoalveolar lavage to diagnose Pneumocystis carinii pneumonia. AU - Yung,R C, AU - Weinacker,A B, AU - Steiger,D J, AU - Miller,T R, AU - Stern,E J, AU - Salmon,C J, AU - Chernoff,D N, AU - Luistro,M G, AU - Kuntz,S, AU - Golden,J A, PY - 1993/12/1/pubmed PY - 1993/12/1/medline PY - 1993/12/1/entrez SP - 1563 EP - 6 JF - The American review of respiratory disease JO - Am Rev Respir Dis VL - 148 IS - 6 Pt 1 N2 - 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. SN - 0003-0805 UR - https://www.unboundmedicine.com/medline/citation/8256901/Upper_and_middle_lobe_bronchoalveolar_lavage_to_diagnose_Pneumocystis_carinii_pneumonia. L2 - https://www.atsjournals.org/doi/10.1164/ajrccm/148.6_Pt_1.1563?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -