Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage.

The effectiveness of fiberoptic bronchoscopy with the addition of bronchoalveolar lavage (BAL) was evaluated in 72 patients with the acquired immune deficiency syndrome (AIDS) and parenchymal pulmonary disease. The diagnostic yield varied for different pathogens and was 94% (45/48 cases) for Pneumocystis carinii, 67% (14/21 cases) for cytomegalovirus, and 62% (8/13 cases) for Mycobacterium avium intracellulare. Of the 11 cases of documented Kaposi's sarcoma in the lung parenchyma, none were diagnosed from bronchoscopy, although characteristic endobronchial lesions were seen in 6 cases. Overall, the yield of bronchoscopy for all pathogens was 65%. Both transbronchial biopsy and BAL had high independent yields (88 and 85%, respectively) for diagnosing P. carinii pneumonia but combining the procedures gave the best yield. Cytomegalovirus was most often diagnosed from examination and culture of the BAL. Recovery of Mycobacterium avium intracellulare was highest with culture of both washings and lavage. Neither granuloma nor organisms were seen on examination of histologic specimens. Bronchoscopy with BAL was well tolerated with few complications even in 5 patients with thrombocytopenia and 10 patients requiring mechanical ventilation. Sixteen patients (22%) had an increase in temperature after the procedure without hypotension or sepsis and 1 patient (1.5%) had a moderate pulmonary hemorrhage after transbronchial biopsy. Fiberoptic bronchoscopy with BAL is a safe procedure with a high diagnostic yield in AIDS patient with lung disease.