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Diffuse alveolar damage. Morphologic features in bronchoalveolar lavage fluid.

C O Beskow1, C B Drachenberg, P M Bourquin

  • 1Department of Pathology, University of Maryland Hospital, Baltimore 21201, USA.

Acta Cytologica
|August 10, 2000
PubMed
Summary

Cytologic examination of bronchoalveolar lavage (BAL) reveals distinct features of diffuse alveolar damage (DAD). These findings aid in diagnosing DAD in BAL specimens when combined with clinical information.

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Area of Science:

  • Pulmonary Pathology
  • Cytopathology
  • Respiratory Medicine

Background:

  • Diffuse alveolar damage (DAD) is a critical lung injury pattern.
  • Accurate diagnosis of DAD is essential for patient management.
  • Bronchoalveolar lavage (BAL) is a minimally invasive diagnostic tool.

Purpose of the Study:

  • To identify and characterize cytologic features of DAD in BAL specimens.
  • To assess the utility of these features for cytologic diagnosis.
  • To correlate BAL cytology with histologic findings.

Main Methods:

  • Evaluation of BAL samples from patients with DAD.
  • Simultaneous collection of BAL with lung biopsies or near autopsy.
  • Routine cytologic and histologic processing of samples.

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Main Results:

  • BAL smears showed high cellularity with abundant alveolar macrophages and desquamated cells.
  • Epithelial cells exhibited nuclear atypia, including hobnailing and squamotization.
  • Amorphous extracellular material and hyaline membranes were observed, correlating with histology.

Conclusions:

  • Cytologic findings in BAL reflect alveolar cell injury characteristic of DAD.
  • DAD can be diagnosed or suggested in BAL samples using these cytologic features.
  • BAL cytology is a valuable tool for DAD diagnosis in the clinical context.