Semin Respir Crit Care Med 2007; 28(5): 514-524
DOI: 10.1055/s-2007-991525
© Thieme Medical Publishers

Bronchoalveolar Lavage in Other Interstitial Lung Diseases

Ulrich Costabel1 , Josune Guzman2 , Francesco Bonella1 , Shinichiro Oshimo1
  • 1Department of Pneumology/Allergy, Ruhrlandklinik, and University of Duisburg-Essen, Essen, Germany
  • 2General and Experimental Pathology, Ruhr-Universität, Bochum, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
02. November 2007 (online)

ABSTRACT

This article reviews the changes in bronchoalveolar lavage (BAL) cytology and cell differentials in some of the rarer interstitial lung diseases. In a few of these diseases BAL has a diagnostic value and can replace lung biopsy. In pulmonary Langerhans cell histiocytosis the characteristic diagnostic finding is an increase in CD1 + Langerhans cells greater than 4% of total cells. The sensitivity of this cutoff value is low because only ~50% of patients show this elevation. In pulmonary alveolar proteinosis, the sensitivity of a diagnostic BAL is almost 100%, and the characteristic finding of milky and turbid fluid on gross examination and the characteristic findings with acellular globules that stain pink with PAS (periodic-acid-Schiff), along with abnormal foamy macrophages and a characteristic dirty background obviates the need for lung biopsy. In diffuse alveolar hemorrhage, BAL is the method of choice to diagnose the alveolar bleeding by showing free red blood cells and hemosiderin-laden, iron-positive macrophages. The underlying disorder has to be identified by history and clinical and laboratory tests. In eosinophilic lung disease, the diagnosis can be made if the BAL cell differentials show 25% or more eosinophils. In collagen vascular disease-associated lung fibrosis, the precise role of BAL in assessment and monitoring disease remains unclear. In drug-induced interstitial lung disease BAL may support a certain clinical/pathological pattern of lung involvement and is helpful for exclusion of other diseases, such as malignancies with pulmonary metastasis, heart disease with pulmonary congestion, or infections. The same is true for radiation-induced lung injury.

REFERENCES

  • 1 Vassallo R, Ryu J H, Colby T V, Hartman T, Limper A H. Pulmonary Langerhans'-cell histiocytosis.  N Engl J Med. 2000;  342 1969-1978
  • 2 Harari S, Caminati A. Pulmonary Langerhans' cell histiocytosis X. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 264-274 Progress in Respiratory Research vol 36
  • 3 Casolaro M A, Bernaudin J F, Saltini C, Ferrans V J, Crystal R G. Accumulation of Langerhans' cells on the epithelial surface of the lower respiratory tract in normal subjects in association with cigarette smoking.  Am Rev Respir Dis. 1988;  137 406-411
  • 4 Soler P, Moreau A, Basset F, Hance A J. Cigarette smoking-induced changes in the number and differentiated state of pulmonary dendritic cells/Langerhans cells.  Am Rev Respir Dis. 1989;  139 1112-1117
  • 5 Kawanami O, Basset F, Ferrans V J, Soler P, Crystal R G. Pulmonary Langerhans' cells in patients with fibrotic lung disorders.  Lab Invest. 1981;  44 227-233
  • 6 Birbeck M S, Breathnach A S, Everall J D. An electron microscopic study of basal melanocytes and high level clear cells (Langerhans' cells) in vitiligo.  J Invest Dermatol. 1961;  37 51-64
  • 7 Murphy G F, Bhan A K, Sato S et al.. A new immunologic marker for human Langerhans cells.  N Engl J Med. 1981;  304 791
  • 8 Webber D, Tron V, Askin F, Churg A. S-100 staining in the diagnosis of eosinophilic granuloma of the lung.  Am J Clin Pathol. 1985;  84 447-453
  • 9 Smetana Jr K, Mericka O, Saeland S et al.. Diagnostic relevance of Langerin detection in cells from bronchoalveolar lavage of patients with pulmonary Langerhans cell histiocytosis, sarcoidosis and idiopathic pulmonary fibrosis.  Virchows Arch. 2004;  444 171-174
  • 10 Sholl L M, Hornick J L, Pinkus J L et al.. Immunohistochemical analysis of langerin in Langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases.  Am J Surg Pathol. 2007;  31 947-952
  • 11 Danel C, Israel-Biet D, Costabel U, Wallert B, Klech H. The clinical role of BAL in rare pulmonary diseases.  Eur Respir Rev. 1991;  8 83-88
  • 12 Costabel U, Guzman J. Bronchoalveolar lavage in interstitial lung disease.  Curr Opin Pulm Med. 2001;  7 255-261
  • 13 Basset F, Soler P, Jaurand M C, Bignon J. Ultrastructural examination of broncho-alveolar lavage for diagnosis of pulmonary histiocytosis X: preliminary report on 4 cases.  Thorax. 1977;  32 303-306
  • 14 Bonnet D, Kermarec J, Marotel C et al.. Data of broncho-alveolar lavage and pulmonary histiocytosis X.  Rev Pneumol Clin. 1987;  43 121-130
  • 15 Auerswald U, Barth J, Magnussen H. Value of CD-1-positive cells in bronchoalveolar lavage fluid for the diagnosis of pulmonary histiocytosis X.  Lung. 1991;  169 305-309
  • 16 Chollet S, Soler P, Dournovo P, Richard M S, Ferrans V J, Basset F. Diagnosis of pulmonary histiocytosis X by immunodetection of Langerhans cells in bronchoalveolar lavage fluid.  Am J Pathol. 1984;  115 225-232
  • 17 Uebelhoer M, Bewig B, Sternberg K et al.. Alveolar macrophages from bronchoalveolar lavage of patients with pulmonary histiocytosis X: determination of phenotypic and functional changes.  Lung. 1995;  173 187-195
  • 18 Hance A J, Basset F, Saumon G et al.. Smoking and interstitial lung disease: the effect of cigarette smoking on the incidence of pulmonary histiocytosis X and sarcoidosis.  Ann N Y Acad Sci. 1986;  465 643-656
  • 19 Sledziewska J, Roginska E, Oblakowski P et al.. Usefulness of CD1 expression on surfaces of cells in bronchoalveolar fluid for diagnosis of histiocytosis X: our experience.  Pneumonol Alergol Pol. 1999;  67 311-317
  • 20 Morell F, Reyes L, Majo J, Orriols R, Roman A. Langerhans cell histiocytosis: clinical longitudinal study of 21 patients.  Med Clin (Barc). 2000;  115 60-64
  • 21 Teschler H, Wang Y M, Konietzko N, Costabel U. Bronchoalveolaere Lavage: Stellenwert in der Diagnostik seltener Lungenerkrankungen.  Atemw Lungenkrkh Jahrgang. 1989;  15 625-630
  • 22 Xaubet A, Agusti C, Picado C et al.. Bronchoalveolar lavage analysis with anti-T6 monoclonal antibody in the evaluation of diffuse lung diseases.  Respiration. 1989;  56 161-166
  • 23 Seymour J F, Presneill J J. Pulmonary alveolar proteinosis: progress in the first 44 years.  Am J Respir Crit Care Med. 2002;  166 215-235
  • 24 Trapnell B C, Whitsett J A, Nakata K. Pulmonary alveolar proteinosis.  N Engl J Med. 2003;  349 2527-2539
  • 25 Costabel U, Bauer P C, Guzman J. Acquired idiopathic pulmonary alveolar proteinosis. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 285-291 Progress in Respiratory Research vol 36
  • 26 Kitamura T, Tanaka N, Watanabe J et al.. Idiopathic pulmonary alveolar proteinosis as an autoimmune disease with neutralizing antibody against granulocyte/macrophage colony-stimulating factor.  J Exp Med. 1999;  190 875-880
  • 27 Kitamura T, Uchida K, Tanaka N et al.. Serological diagnosis of idiopathic pulmonary alveolar proteinosis.  Am J Respir Crit Care Med. 2000;  162 658-662
  • 28 Bonfield T L, Russell D, Burgess S et al.. Autoantibodies against granulocyte macrophage colony-stimulating factor are diagnostic for pulmonary alveolar proteinosis.  Am J Respir Cell Mol Biol. 2002;  27 481-486
  • 29 Yoshida M, Ikegami M, Reed J A et al.. GM-CSF regulates protein and lipid catabolism by alveolar macrophages.  Am J Physiol Lung Cell Mol Physiol. 2001;  280 L379-L386
  • 30 Uchida K, Nakata K, Trapnell B C et al.. Granulocyte-macrophage colony-stimulating factor activity in the lungs of patients with idiopathic pulmonary alveolar proteinosis.  Blood. 2004;  103 1089-1098
  • 31 Haslam P, Hughes D, Deware A et al.. Lipoprotein macroaggregates in BAL fluid from patients with diffuse interstitial lung diseases: comparison with idiopathic alveolar proteinosis.  Thorax. 1988;  43 140-146
  • 32 Honda Y, Katoka K, Hayashi H et al.. Alterations of acidic phospholipids in bronchoalveolar lavage fluids of patients with pulmonary alveolar proteinosis.  Clin Chim Acta. 1989;  181 11-18
  • 33 Doyle I R, Davidson K G, Barr H A et al.. Quantity and structure of surfactant proteins vary among patients with alveolar proteinosis.  Am J Respir Crit Care Med. 1998;  157 658-664
  • 34 Crouch E, Persson A, Chang D. Accumulation of surfactant protein D in human pulmonary alveolar proteinosis.  Am J Pathol. 1993;  142 241-248
  • 35 Honda Y, Takahashi H, Shijubo N, Kuroki Y, Akino T. Surfactant protein-A concentration in bronchoalveolar lavage fluids of patients with pulmonary alveolar proteinosis.  Chest. 1993;  103 496-499
  • 36 Honda Y, Kuroki Y, Matsuura E et al.. Pulmonary surfactant protein D in sera and bronchoalveolar lavage fluids.  Am J Respir Crit Care Med. 1995;  152 1860-1866
  • 37 Kuroki Y, Tsutahara S, Shijubo N et al.. Elevated levels of lung surfactant protein A in sera from patients with idiopathic pulmonary fibrosis and pulmonary alveolar proteinosis.  Am Rev Respir Dis. 1993;  147 723-729
  • 38 Hirakata Y, Kobayashi J, Sugama Y, Kitamura S. Elevation of tumour markers in serum and bronchoalveolar lavage fluid in pulmonary alveolar proteinosis.  Eur Respir J. 1995;  8 689-696
  • 39 Hoffmann R M, Dauber J M, Rogers R M. Improvement in alveolar macrophage migration after whole lung lavage in pulmonary alveolar proteinosis.  Am Rev Respir Dis. 1989;  139 1030-1032
  • 40 Golde D W, Territo M, Finley T N et al.. Defective lung macrophages in pulmonary alveolar proteinosis.  Ann Intern Med. 1976;  85 304-309
  • 41 Nugent K M, Pesanti E L. Macrophage function in pulmonary alveolar proteinosis.  Am Rev Respir Dis. 1983;  127 780-781
  • 42 Gonzales-Rothi R M, Harris J O. Pulmonary alveolar proteinosis: further evaluation of abnormal alveolar macrophages.  Chest. 1986;  90 646-661
  • 43 Martin R J, Coalson J J, Rogers F M et al.. Pulmonary alveolar proteinosis: the diagnosis by segmental lavage.  Am Rev Respir Dis. 1980;  121 819-825
  • 44 Maygarden S J, Iacocca M V, Funkhouser W K, Novotny D B. Pulmonary alveolar proteinosis: a spectrum of cytologic, histochemical, and ultrastructural findings in bronchoalveolar lavage fluid.  Diagn Cytopathol. 2001;  24 389-395
  • 45 Mermolja M, Rott T, Debeljak A. Cytology of bronchoalveolar lavage in some rare pulmonary disorders: pulmonary alveolar proteinosis and amiodarone pulmonary toxicity.  Cytopathology. 1994;  5 9-16
  • 46 Burkhalter A, Silverman J F, Hopkins III M B, Geisinger K R. Bronchoalveolar lavage cytology in pulmonary alveolar proteinosis.  Am J Clin Pathol. 1996;  106 504-510
  • 47 Mikami T, Yamamoto Y, Yokoyama M, Okayasu I. Pulmonary alveolar proteinosis: diagnosis using routinely processed smears of bronchoalveolar lavage fluid.  J Clin Pathol. 1997;  50 981-984
  • 48 Chou C W, Lin F C, Tung S M, Liou R D, Chang S C. Diagnosis of pulmonary alveolar proteinosis: usefulness of Papanicolaou-stained smears of bronchoalveolar lavage fluid.  Arch Intern Med. 2001;  161 562-566
  • 49 Hook G E, Gilmore L B, Talley F A. Multilamelled structures from the lungs of patients with pulmonary alveolar proteinosis.  Lab Invest. 1984;  50 711-725
  • 50 Milleron B J, Costabel U, Teschler H et al.. Bronchoalveolar lavage cell data in alveolar proteinosis.  Am Rev Respir Dis. 1991;  144 1330-1332
  • 51 Johkoh T, Itoh H, Muller N L et al.. Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings.  Radiology. 1999;  211 155-160
  • 52 Crocker H L, Pfitzner J, Doyle I R et al.. Pulmonary alveolar proteinosis: two contrasting cases.  Eur Respir J. 2000;  15 426-429
  • 53 Olson A L, Schwarz M I. Diffuse alveolar hemorrhage. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 250-263 Progress in Respiratory Research vol 36
  • 54 Zamora M R, Warner M L, Tuder R et al.. Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome.  Medicine (Baltimore). 1997;  76 192-202
  • 55 Leatherman J W, Davies S F, Hoidal J R. Alveolar hemorrhage syndromes: diffuse microvascular lung hemorrhage in immune and idiopathic disorders.  Medicine (Baltimore). 1984;  63 343-361
  • 56 Green R J, Ruoss S J, Kraft S A, Duncan S R, Berry G J, Raffin T A. Pulmonary capillaritis and alveolar hemorrhage: update on diagnosis and management.  Chest. 1996;  110 1305-1316
  • 57 Robbins R A, Linder J, Stahl M G et al.. Diffuse alveolar hemorrhage in autologous bone marrow transplant host.  Am Rev Respir Dis. 1987;  136 155-160
  • 58 Agusti C, Ramirez J, Picado C et al.. Diffuse alveolar hemorrhage in allogeneic bone marrow transplantation: a postmortem study.  Am J Respir Crit Care Med. 1995;  151 1006-1010
  • 59 Huaringa A J, Leyva F J, Signes-Costa J et al.. Bronchoalveolar lavage in the diagnosis of pulmonary complications of bone marrow transplant patients.  Bone Marrow Transplant. 2000;  25 975-979
  • 60 Golde D, Drew L, Klein H et al.. Occult hemorrhage in leukemia.  BMJ. 1975;  2 166-168
  • 61 Drew W L, Finley T N, Golde D W. Diagnostic lavage and occult pulmonary hemorrhage in thrombocytopenic immunocompromised patients.  Am Rev Respir Dis. 1977;  116 215-221
  • 62 Kahn F W, Jones J M, England D M. Diagnosis of pulmonary hemorrhage in the immunocompromised host.  Am Rev Respir Dis. 1987;  136 155-160
  • 63 De Lassence A, Fleury-Feith J, Escudier E, Beaune J, Bernaudin J F, Cordonnier C. Alveolar hemorrhage: diagnostic criteria and results in 194 immunocompromised hosts.  Am J Respir Crit Care Med. 1995;  151 157-163
  • 64 Grebski E, Hess T, Hold G, Speich R, Russi E. Diagnostic value of hemosiderin-containing macrophages in bronchoalveolar lavage.  Chest. 1992;  102 1794-1799
  • 65 Sherman J M, Winnie G, Thomassen M J, Abdul-Karim F W, Boat T F. Time course of hemosiderin production and clearance by human pulmonary macrophages.  Chest. 1984;  86 409-411
  • 66 Epstein C E, Elidemir O, Colasurdo G N, Fan L L. Time course of hemosiderin production by alveolar macrophages in a murine model.  Chest. 2001;  120 2013-2020
  • 67 Costabel U. Atlas of Bronchoalveolar Lavage. London; Chapman and Hall 1998
  • 68 Linder J, Robbins R A, Rennard S I. Cytological criteria for diffuse alveolar hemorrhage.  Acta Cytol. 1988;  32 763
  • 69 Perez-Arellano J L, Losa Garcia J E, Garcia Macias M C, Gomez G F, Jimenez L A, de Castro S. Hemosiderin-laden macrophages in bronchoalveolar lavage fluid.  Acta Cytol. 1992;  36 26-30
  • 70 Moumouni H, Lamotte F, Anthonioz P. Sideroses of alveolar macrophages: analysis of a continuous series of 360 bronchoalveolar lavages.  Pathol Biol (Paris). 1993;  41 604-609
  • 71 Lazor R, Cordier J F. Idiopathic eosinophilic pneumonias. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 238-249 Progress in Respiratory Research vol 36
  • 72 Velay B, Pages J, Cordier J F et al.. Hyperéosinophilie du lavage bronchoalvéolaire: valeur diagnostique etr corrélations avec l'éosinophilie sanguine.  Rev Mal Respir. 1987;  4 257-260
  • 73 Allen J N, Davis W B, Pacht E R. Diagnostic significance of increased bronchoalveolar lavage fluid eosinophils.  Am Rev Respir Dis. 1990;  142 642-647
  • 74 Costabel U, Teschler H, Guzman J. Bronchiolitis obliterans organizing pneumonia (BOOP): the cytological and immunocytological profile of bronchoalveolar lavage.  Eur Respir J. 1992;  5 791-797
  • 75 Schnabel A, Reuter M, Gloeckner K, Muller-Quernheim J, Gross W L. Bronchoalveolar lavage cell profiles in Wegener's granulomatosis.  Respir Med. 1999;  93 498-506
  • 76 Schnabel A, Csernok E, Braun J, Gross W L. Inflammatory cells and cellular activation in the lower respiratory tract in Churg-Strauss syndrome.  Thorax. 1999;  54 771-778
  • 77 Hoyles R K, Wells A U. Pulmonary fibrosis in collagen vascular disease. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 185-195 Progress in Respiratory Research vol 36
  • 78 Wallaert B, Hoorelbeke A, Sibille Y, Rossi G A. The clinical role of bronchoalveolar lavage in collagen-vascular diseases. In: Klech H, Hutter C, Costabel U Clinical Guidelines and Indications for Bronchoalveolar Lavage (BAL). Eur Respir Rev 1992 2: 64-68
  • 79 Greene N B, Solinger A M, Baughman R P. Patients with collagen vascular diseases and dyspnea: the value of gallium scanning and bronchoalveolar lavage in predicting response to steroid therapy and clinical outcome.  Chest. 1987;  91 698-703
  • 80 König G, Luderschmidt C, Hammer C et al.. Lung involvement in scleroderma.  Chest. 1984;  127 318-324
  • 81 Frigieri L, Mormile F, Grilli N et al.. Bilateral bronchoalveolar lavage in progressive systemic sclerosis: interlobar variability, lymphocyte subpopulations, and functional correlations.  Respiration. 1991;  58 132-140
  • 82 Silver R M, Miller K S, Kinsella M B, Smith E A, Schabel S I. Evaluation and management of scleroderma lung disease using bronchoalveolar lavage.  Am J Med. 1990;  88 470-476
  • 83 Behr J, Vogelmeier C, Beinert T et al.. Bronchoalveolar lavage for evaluation and management of scleroderma disease of the lung.  Am J Respir Crit Care Med. 1996;  154 400-406
  • 84 Bouros D, Wells A U, Nicholson A G et al.. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome.  Am J Respir Crit Care Med. 2002;  165 1581-1586
  • 85 Wells A U, Hansell D M, Rubens M B et al.. Fibrosing alveolitis in systemic sclerosis: bronchoalveolar lavage findings in relation to computed tomographic appearance.  Am J Respir Crit Care Med. 1994;  150 462-468
  • 86 White B, Moore W C, Wigley F M, Xiao H Q, Wise R A. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis.  Ann Intern Med. 2000;  132 947-954
  • 87 Garcia J G, Parhami N, Killam D, Garcia P L, Keogh B A. Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis.  Am Rev Respir Dis. 1986;  133 450-454
  • 88 Popp W, Ritschka L, Scherak O et al.. Bronchoalveolar lavage in rheumatoid arthritis and secondary Sjögren's syndrome.  Lung. 1990;  168 221-231
  • 89 Ishioka S, Inyaku K, Shirotani Y et al.. Bronchoalveolar lavage fluid findings in rheumatoid arthritis.  Nihon Kyobu Shikkan Gakkai Zasshi. 1992;  30 614-618
  • 90 Balbi B, Cosulich E, Risso A et al.. The interstitial lung disease associated with rheumatoid arthritis: evidence for imbalance of helper T-lymphocyte subpopulations at sites of disease activity.  Bull Eur Physiopathol Respir. 1987;  23 241-247
  • 91 Dalavanga Y A, Voulgari P V, Georgiadis A N et al.. Lymphocytic alveolitis: a surprising index of poor prognosis in patients with primary Sjögren's syndrome.  Rheumatol Int. 2006;  26 799-804
  • 92 Deheinzelin D, Capelozzi V L, Kairalla R A, Barbas Filho J V, Saldiva P H, de Carvalho C R. Interstitial lung disease in primary Sjögren's syndrome: clinical-pathological evaluation and response to treatment.  Am J Respir Crit Care Med. 1996;  154 794-799
  • 93 Salaffi F, Manganelli P, Carotti M et al.. A longitudinal study of pulmonary involvement in primary Sjögren's syndrome: relationship between alveolitis and subsequent lung changes on high-resolution computed tomography.  Br J Rheumatol. 1998;  37 263-269
  • 94 Grau J M, Miro O, Pedrol E et al.. Interstitial lung disease related to dermatomyositis: comparative study with patients without lung involvement.  J Rheumatol. 1996;  23 1921-1926
  • 95 Komocsi A, Kumanovics G, Zibotics H, Czirjak L. Alveolitis may persist during treatment that sufficiently controls muscle inflammation in myositis.  Rheumatol Int. 2001;  20 113-118
  • 96 Schnabel A, Reuter M, Biederer J, Richter C, Gross W L. Interstitial lung disease in polymyositis and dermatomyositis: clinical course and response to treatment.  Semin Arthritis Rheum. 2003;  32 273-284
  • 97 Pesci A, Bertorelli G, Manganelli P, Ambanelli U. Bronchoalveolar lavage analysis of interstitial lung disease in CREST syndrome.  Clin Exp Rheumatol. 1986;  4 121-124
  • 98 Enomoto K, Takada T, Suzuki E et al.. Bronchoalveolar lavage fluid cells in mixed connective tissue disease.  Respirology. 2003;  8 149-156
  • 99 Kumanovics G, Magyarlaki T, Komocsi A, Szekeres G, Czirjak L. Simultaneous presence of neutrophil alveolitis and Ki-67 positivity of alveolar macrophages in dermato-/polymyositis.  Rheumatol Int. 2003;  23 6-10
  • 100 Camus P. Drug-induced and iatrogenic infiltrative lung disease. In: Costabel U, Du Bois RM, Egan JJ Diffuse Parenchymal Lung Disease. Basel; Karger 2007: 212-237 Progress in Respiratory Research vol 36
  • 101 Costabel U, Uzaslan E, Guzman J. Bronchoalveolar lavage in drug-induced lung disease.  Clin Chest Med. 2004;  25 25-35
  • 102 Israel-Biet D, Venet A, Caubarrere I et al.. Bronchoalveolar lavage in amiodarone pneumonitis: cellular abnormalities and their relevance to pathogenesis.  Chest. 1987;  91 214-221
  • 103 White D A, Kris M G, Stover D E. Bronchoalveolar lavage cell populations in bleomycin lung toxicity.  Thorax. 1987;  42 551-552
  • 104 Costabel U, Schmitz-Schumann M, Matthys H. Bronchoalveolar T-cell subsets in gold lung.  Chest. 1985;  87 135-136
  • 105 Akoun G M, Cadranel J L, Milleron B J, D'Ortho M P, Mayaud C M. Bronchoalveolar lavage cell data in 19 patients with drug-associated pneumonitis (except amiodarone).  Chest. 1991;  99 98-104
  • 106 White D A, Rankin J A, Stover D E et al.. Methotrexate pneumonitis.  Am Rev Respir Dis. 1989;  139 18-21
  • 107 Schnabel A, Richter C, Bauernfeind S et al.. Bronchoalveolar lavage cell profile in methotrexate induced pneumonitis.  Thorax. 1997;  52 377-379
  • 108 Miyashita N, Nakajima M, Kuroki M et al.. Sulbactam/ampicillin-induced pneumonitis [in Japanese].  Nihon Kokyuki Gakkai Zasshi. 1998;  36 684-689
  • 109 Brutinet W, Martin W. Chronic nitrofurantoin reaction associated with T-lymphocyte alveolitis.  Chest. 1986;  89 150-152
  • 110 Morelon E, Sern M, Israel-Biet D et al.. Characteristics of sirolimus-associated interstitial pneumonitis in renal transplant patients.  Transplantation. 2001;  72 787-790
  • 111 Akoun G M, Cadranel J L, Blanchette G, Milleron B J, Mayaud C M. Bronchoalveolar lavage cell data in amiodarone-associated pneumonitis: evaluation in 22 patients.  Chest. 1991;  99 1177-1182
  • 112 Coudert B, Bailly F, Lombard J N et al.. Amiodarone pneumonitis: bronchoalveolar lavage findings in 15 patients and review of the literature.  Chest. 1992;  102 1005-1012
  • 113 Ohar J A, Jackson F, Dettenmeier P A et al.. Bronchoalveolar lavage cell count and differential are not reliable indicators of amiodarone-induced pneumonitis.  Chest. 1992;  102 999-1004
  • 114 Akoun G M, Milleron B J, Mayaud C M, Tholoniat D. Provocation test coupled with bronchoalveolar lavage in diagnosis of propanolol-induced hypersensitivity pneumonitis.  Am Rev Respir Dis. 1989;  139 247-249
  • 115 Akoun G M, Liote H A, Liote F, Gauthier-Rahman S, Kuntz D. Provocation test coupled with bronchoalveolar lavage in diagnosis of drug (nilutamide)-induced hypersensitivity pneumonitis.  Chest. 1990;  97 495-498
  • 116 Israel-Biet D, Labrune S, Huchon G J. Drug-induced lung disease: 1990 review.  Eur Respir J. 1991;  4 465-478
  • 117 Bonaccorsi A, Cancellieri A, Chilosi M et al.. Acute interstitial pneumonia: report of a series.  Eur Respir J. 2003;  21 187-191
  • 118 Abratt R P, Onc F R, Morgan G W et al.. Pulmonary complications of radiation therapy.  Clin Chest Med. 2004;  25 167-177
  • 119 Bayle J Y, Nesme P, Bejui-Thivolet F et al.. Migratory organising pneumonitis “primed” by radiation therapy.  Eur Respir J. 1995;  8 322-326
  • 120 Arbetter K R, Prakash U BS, Tazelaar H D et al.. Radiation-induced pneumonitis in the “non-irradiated” lung.  Mayo Clin Proc. 1999;  74 27-36
  • 121 Martin C, Romero S, Sanchez-Paya J et al.. Bilateral lymphocytic alveolitis: a common reaction after unilateral thoracic irradiation.  Eur Respir J. 1999;  13 727-732
  • 122 Cottin V, Frognier R, Monnot H et al.. Chronic eosinophilic pneumonia after radiation therapy for breast cancer.  Eur Respir J. 2004;  23 9-13
  • 123 Morgan G W, Breit S N. Radiation and the lung: a reevaluation of the mechanisms mediating pulmonary injury.  Int J Radiat Oncol Biol Phys. 1995;  31 361-369
  • 124 Cordier J F, Mornex J F, Lasne Y et al.. Bronchoalveolar lavage in radiation pneumonitis.  Bull Eur Physiopathol Respir. 1984;  20 369-374
  • 125 Nakayama Y, Makino S, Fukuda Y, Min K Y, Shimizu A, Ohsawa N. Activation of lavage lymphocytes in lung injuries caused by radiotherapy for lung cancer.  Int J Radiat Oncol Biol Phys. 1996;  34 459-467
  • 126 Gibson P G, Bryant D H, Morgan G W et al.. Radiation-induced lung injury: a hypersensitivity pneumonitis?.  Ann Intern Med. 1988;  109 288-291
  • 127 Roberts C M, Foulcher E, Zaunders J J et al.. Radiation pneumonitis: a possible lymphocyte-mediated hypersensitivity reaction.  Ann Intern Med. 1993;  118 696-700
  • 128 Crestani B, Valeyre D, Roden S et al.. Bronchiolitis obliterans organising pneumonia syndrome primed by radiation therapy to the breast.  Am J Respir Crit Care Med. 1998;  158 1929-1935

Ulrich CostabelM.D. 

Department of Pneumology/Allergy

Ruhrlandklinik, 45239 Essen, Germany

eMail: ulrich.costabel@ruhrlandklinik.de