Analysis of homogeneity of alveolitis in pulmonary sarcoidosis by bilateral bronchoalveolar lavage, gallium-67 lung uptake, and chest radiograph.

The use of unilateral lobar bronchoalveolar lavage (BAL) to assess disease activity in pulmonary sarcoidosis assumes that the alveolitis is homogeneous throughout the lung parenchyma. Three studies were used to evaluate this premise in 21 patients with sarcoidosis who had a broad range of abnormalities: bilateral BAL cell counts, quantitated regional gallium-67 lung uptake, and analysis of chest radiographs. Based on results of these studies, we conclude that the alveolitis in sarcoidosis is homogeneous in the majority of patients, although lavage of the lingula may give erroneous results due to the frequently increased proportion of neutrophils. The only moderate level of correlation between the BAL % lymphocytes and gallium-67 lung uptake, even when the same regions of the lung are studied, suggests that these tests may measure different aspects of disease activity.