Related Experiment Video
Updated: May 16, 2026
Bronchoalveolar Lavage of Murine Lungs to Analyze Inflammatory Cell Infiltration
Published on: May 4, 2017
Cytologic findings of acute leukemia in bronchoalveolar lavage fluid
Michelle O'Leary1, Richard L Cantley, Larry Kluskens
1Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA.
Insights
Bronchoalveolar lavage (BAL) can diagnose leukemia in patients with lung infiltrates, mimicking infection. This procedure aids in differentiating leukemic from inflammatory processes, crucial for acute leukemia management.
Area of Science:
- Pulmonary Medicine
- Hematology
- Diagnostic Cytology
Background:
- Acute leukemia patients with respiratory symptoms often undergo bronchoalveolar lavage (BAL) to exclude infection.
- Pulmonary infiltrates in leukemia can be caused by infection, inflammation, or leukemic cell infiltration.
- Differentiating leukemic lung involvement from infection is critical for appropriate patient management.
Purpose of the Study:
- To evaluate the diagnostic utility of bronchoalveolar lavage (BAL) in identifying leukemic infiltrates in patients with acute leukemia.
- To assess the role of BAL in differentiating leukemic lung disease from infectious or inflammatory processes.
- To analyze the clinical characteristics and outcomes of leukemia patients diagnosed via BAL.
Main Methods:
- Retrospective review of 1,130 bronchoalveolar lavage (BAL) samples collected between January 1, 2006, and December 31, 2008.
- Analysis of cytological findings in BAL fluid for malignant cells, specifically focusing on leukemia.
- Review of clinical data, including patient demographics, leukemia type, symptoms, imaging, and outcomes for confirmed cases.
Main Results:
- Twelve cases of leukemia were diagnosed using BAL material, with 10 identified through initial search criteria.
- Leukemic infiltrates mimicked infectious or inflammatory processes on chest X-rays in all analyzed cases.
- The study identified various types of acute leukemia and myelodysplastic syndromes; patient outcomes were generally poor, with 7 of 12 patients dying.
Conclusions:
- Bronchoalveolar lavage (BAL) is a valuable and safe diagnostic tool for detecting leukemic infiltrates in the lungs of acute leukemia patients.
- BAL can effectively distinguish leukemic lung involvement from infection, guiding timely and appropriate treatment decisions.
- Lung involvement in acute leukemia carries a poor prognosis, underscoring the importance of early diagnosis.
Abstract:
Bronchoalveolar lavage (BAL) is often performed in patients with acute leukemia developed with respiratory failure or pulmonary infiltrates. Patients usually undergo BAL to rule out infection. Occasionally, however, leukemic infiltrate may be detected. We present a series of 11 cases in which the diagnosis of leukemia was made on the BAL material. We retrospectively reviewed all BAL samples from January 1, 2006 to December 31, 2008. There were a total of 1,130 cases, of which 139 showed malignant cytology, including 10 with leukemia. Sixteen samples were unsatisfactory and 904 were benign, of which 32 had identifiable microorganisms. In additional to the 10 leukemia cases identified, two more were reviewed after the search criteria. The 12 patients (seven men, five women) ranged from 22 to 75 years old. All patients had previously biopsy-proven leukemia [two acute myelomonocytic leukemia, two acute promyelocytic leukemia, two acute myeloid leukemia (AML) with inv16, two therapy-related AML, one acute monocytic leukemia, one chronic myeloid leukemia in blast face, one AML with maturation, one myelodysplastic syndrome with excess blasts, and one large granular leukemia]. Four had a prior diagnosis of myelodysplastic syndrome. The time from initial diagnosis of leukemia to BAL ranged from 1 to 233 days, with 8 of 10 occurring within 8 days of diagnosis. Symptoms that prompted BAL included shortness of breath/hypoxia (8), fever (3), chest pain (2), and cough (2). Chest X-rays in all cases revealed opacities or consolidations mimicking an inflammatory process. Seven patients subsequently died, while three were alive, and, in remission, and two were lost to follow-up. The presence of a leukemic infiltrate can mimic infection. BAL is a relatively safe and useful diagnostic tool in this setting for differentiating a leukemic infiltrate from an infection/inflammatory infiltrate. The prognosis of patients with lung involvement of acute leukemia is poor.
