Julie R Park1, Shana Fogarty, Thomas V Brogan. 1. Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children's Hospital and Regional Medical Center, University of Washington Medical School, Seattle, Washington 98105, USA. ipark2@chmc.org
Abstract
BACKGROUND: Pulmonary disease in the pediatric cancer patient continues to pose a difficult clinical dilemma. Bronchoalveolar lavage (BAL) is commonly utilized for the diagnosis of pulmonary complications in the immunocompromised child. PROCEDURE: We retrospectively reviewed 53 BAL procedures performed in pediatric cancer patients with pulmonary disease between 1988 and 1998 to determine the diagnostic and clinical utility of BAL. Patients who had undergone prior myeloablative therapy were excluded from analysis. RESULTS: The majority of patients (83%) had an underlying diagnosis of acute leukemia or lymphoma. BAL yielded a specific diagnosis in 16 patients (30%), including 15 infections and 1 malignant infiltration. Medical management was altered in an additional 14 patients (26%) as a consequence of a negative BAL result. Severe but transient complications associated with the BAL procedure occurred in four patients (8%). Minor complications following the BAL occurred in 21 patients (40%) and included transiently increased oxygen requirement and anesthesia-related gastrointestinal complaints. The mortality from lung disease in this patient population was 7.5%. CONCLUSIONS: Both positive and negative BAL results contribute to the management of pediatric cancer patients with pulmonary disease. The low incidence of significant complications associated with BAL and the high mortality rate in this patient population support the choice of BAL as an initial diagnostic test in pediatric cancer patients with pulmonary disease. Copyright 2002 Wiley-Liss, Inc.
BACKGROUND:Pulmonary disease in the pediatric cancerpatient continues to pose a difficult clinical dilemma. Bronchoalveolar lavage (BAL) is commonly utilized for the diagnosis of pulmonary complications in the immunocompromised child. PROCEDURE: We retrospectively reviewed 53 BAL procedures performed in pediatric cancerpatients with pulmonary disease between 1988 and 1998 to determine the diagnostic and clinical utility of BAL. Patients who had undergone prior myeloablative therapy were excluded from analysis. RESULTS: The majority of patients (83%) had an underlying diagnosis of acute leukemia or lymphoma. BAL yielded a specific diagnosis in 16 patients (30%), including 15 infections and 1 malignant infiltration. Medical management was altered in an additional 14 patients (26%) as a consequence of a negative BAL result. Severe but transient complications associated with the BAL procedure occurred in four patients (8%). Minor complications following the BAL occurred in 21 patients (40%) and included transiently increased oxygen requirement and anesthesia-related gastrointestinal complaints. The mortality from lung disease in this patient population was 7.5%. CONCLUSIONS: Both positive and negative BAL results contribute to the management of pediatric cancerpatients with pulmonary disease. The low incidence of significant complications associated with BAL and the high mortality rate in this patient population support the choice of BAL as an initial diagnostic test in pediatric cancerpatients with pulmonary disease. Copyright 2002 Wiley-Liss, Inc.
Authors: Philip Zachariah; Chanelle Ryan; Sruti Nadimpalli; Gina Coscia; Michelle Kolb; Hannah Smith; Marc Foca; Lisa Saiman; Paul J Planet Journal: Ann Am Thorac Soc Date: 2018-09
Authors: U Rao; A Piccin; A Malone; K O'Hanlon; F Breatnach; A O'Meara; M McDermott; K Butler; N O'Sullivan; J Russell; A O'Marcaigh; O P Smith Journal: Ir J Med Sci Date: 2012-09-16 Impact factor: 1.568
Authors: Sruti Nadimpalli; Marc Foca; Prakash Satwani; Maria Luisa Sulis; Andrei Constantinescu; Lisa Saiman Journal: Pediatr Pulmonol Date: 2017-01-03
Authors: Ali H Ahmad; Brandon D Brown; Clark R Andersen; Kris M Mahadeo; Demetrios Petropolous; José A Cortes; Shehla Razvi; Mary Katherine Gardner; Linette J Ewing; Rodrigo E Mejia Journal: Front Oncol Date: 2021-12-14 Impact factor: 6.244