title: Bronchoalveolar lavage cellular analyses in conjunction with high-resolution computed tomography imaging as a diagnostic intervention for patients with suspected interstitial lung disease.
abstract: BACKGROUND
  Bronchoalveolar lavage (BAL) has gained acceptance for diagnosis of Interstitial lung disease (ILD). The advent of high-resolution computed tomography (HRCT) has reduced the clinical utility of BAL. This work has utilized the recommendations of the American Thoracic Society (ATS) to optimize BAL and the findings have been associated with clinical examination and HRCT to precisely narrow down the cause of ILD.
  
  
  METHODS
  BAL was performed on ILD suspects at the target site chosen based on HRCT. The procedure, transport, processing, and analysis of BAL fluid were performed as per the ATS guidelines. The clinical data, HRCT findings and BAL report were used to narrow down the diagnosis of ILD. The statistical analysis was performed to assess the significance.
  
  
  RESULTS
  The BAL procedure was optimized as per the recommendations of the ATS. In a cohort of 50 patients, Idiopathic pulmonary fibrosis, (8) hypersensitivity pneumonitis, (17) connective tissue disorder, (9) sarcoidosis, (3) pneumoconiosis, (5) acute respiratory distress syndrome, (2) eosinophilic lung disease (2) and lymphangitic carcinomatosa, (2) aspiration bronchiolitis (1) and pulmonary histiocytosis (1) were diagnosed. Statistically significant variation in differential counts was found in different ILDs. The different ILDs were classified based on the criteria described by the ATS.
  
  
  CONCLUSIONS
  BAL along with clinical and HRCT findings improved the diagnostic accuracy by incorporating, the acute or chronic nature of the disease and the cause for acute exacerbation, which helped in the better management of ILDs.
authors.affiliation: Department of Thoracic Medicine, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Ammaiyappan
authors.initials: A
authors.lastname: Chockalingam
authors.affiliation: Department of Thoracic Medicine, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Ranganathan
authors.initials: R
authors.lastname: Duraiswamy
authors.affiliation: Dualhelix Genetic Diagnostics, Chennai, Tamil Nadu, India; Vasan Medical Research Trust, Chennai, Tamil Nadu, India.
authors.forename: Madhavan
authors.initials: M
authors.lastname: Jagadeesan
keywords: ATS recommendations; Interstitial lung diseases; bronchoalveolar lavage