The value of bronchial washings and bronchoalveolar lavage in the diagnosis of lymphangitic carcinomatosis.

This study examines the value of bronchoalveolar lavage (BAL) in diagnosing lymphangitic carcinomatosis. A retrospective analysis of fiberoptic bronchoscopic records at a tertiary referral hospital was performed. Twelve patients with neoplastic disease and diffuse pulmonary infiltrates compatible with lymphangitic carcinomatosis who underwent diagnostic fiberoptic bronchoscopy were identified. Bronchoalveolar lavage correctly identified five (100 percent) out of five patients, bronchial washings identified four (57 percent) of seven patients and either procedure identified nine (75 percent) of 12 patients. Bronchial brushings were positive in two (40 percent) of five patients, and transbronchial lung biopsy confirmed the diagnosis in only four (44 percent) of nine patients. Transbronchial lung biopsy was uniquely positive in only one patient. One patient had a significant pulmonary hemorrhage following transbronchial lung biopsy, while no complications of BAL occurred. Two patients had significant coagulopathy, and one patient was severely agitated precluding transbronchial lung biopsy, and all three were positive by BAL. This study suggests that BAL should be performed to confirm the diagnosis of lymphangitic carcinomatosis before proceeding to a biopsy, especially when the risks of pneumothorax and hemorrhage are excessive.