Diagnosis of alveolitis in interstitial lung manifestation in connective tissue diseases: importance of late inspiratory crackles, 67 gallium scan and bronchoalveolar lavage.

The diagnostic relevance of bronchoalveolar lavage (BAL) and associated non-invasive findings in connective tissue diseases (CTD) has not been established regarding alveolitis so far. The goal of the study was to determine the relations between BAL cell differential count and findings of non-invasive diagnostic procedures for alveolitis to predict the clinical value of BAL in CTD. One hundred-five patients (92 non-smokers; 13 smokers) with CTD (73 patients with systemic sclerosis, 19 with systemic lupus erythematosus, 13 with primary Sjögren's syndrome) had symptoms or signs of lung involvement and were further examined (lung function test, chest radiography, thoracic computed tomography, 67 gallium scintigraphy and BAL). The relations between BAL in middle lobe and cell count differentiation to non-invasive investigations were analyzed by logistic regression. In all CTD patients investigated a pulmonal involvement occurred based on non-invasive methods. Regarding non-invasive methods, alveolitis determined by BAL cell differential count was significantly associated with an increased 67-gallium uptake and late inspiratory crackles (P < 0.01), and to a lesser extent with an abnormal interstitial pattern in CT (P < 0.055). Parameters of lung function and laboratory parameters were related to alveolitis using multivariate testing. Considering the alveolitis subtype (granulo- or lymphocytosis), only a reduced FEV1 showed a relationship to granulocytic alveolitis (P < 0.01). Late inspiratory crackles and increased 67 gallium uptake as non-invasive diagnostic findings point out alveolitis in CTD remarkably. Therapeutic and prognostic aspects necessitate BAL to specify the type of alveolitis (lymphocytosis or granulocytosis or mixed forms) in CTD patients with lung manifestation. Non-invasive diagnostic procedures cannot predict the type of alveolitis sufficiently.