Bronchoalveolar lavage
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Bronchoalveolar lavage (BAL) is a medical procedure in which a bronchoscope is passed through the mouth or nose into the lungs and fluid is squirted into a small part of the lung and then recollected for examination. BAL is typically performed to diagnose lung disease.[1] In particular, BAL is commonly used to diagnose infections in people with immune system problems,[2] pneumonia in people on ventilators, some types of lung cancer, and scarring of the lung (interstitial lung disease). BAL is the most common manner to sample the components of the epithelial lining fluid (ELF) and to determine the protein composition of the pulmonary airways, and it is often used in immunological research as a means of sampling cells or pathogen levels in the lung. Examples of these include T-cell populations and influenza viral levels. Examples of normal and abnormal BAL cells can be found in this BAL Atlas.
[edit] Limitations
A major clinical limitation for the utility of examining bronchoalveolar lavage fluid (BALf) is the large range of normal values for each parameter, which makes BALf insensitive in detecting disease. Furthermore, abnormalities in BALf are rarely specific for any of the interstitial lung diseases. There are some subjects who have normal BALf constituents despite a definite disease and some without any evidence of disease despite abnormal BALf findings. There is large interindividual variation which may not be related to the disease, and the airspace cells and secretions may not reflect interstitial processes. The removal of BALf may preferentially select, activate or injure some cells, and the composition of the epithelial lining fluid may change during the bronchoalveolar lavage.
[edit] Scientific events
12th International Conference on BAL - http://www.wasogbal2011.nl
[edit] References
[edit] CPT 2009
Lavage Broncnial CPT Code: 31624 Lavage Total CPT Code: 32997
