ROLE OF FOB AND BAL/TBLB IN ETIOLOGICAL DIAGONOSIS OF NON-RESOLVING PNEUMONIAS

Abstract

Background: Fiberoptic bronchoscopy (FOB) and Bronchoalveolar lavage (BAL) may be an important tool in assessment of non- resolving pneumonia (NRP), it has been traditionally used to evaluate NRP, its efficacy is unknown.

Objectives: To asses the impact of bronchoscopy and BAL/TBLB in etiological diagnosis of the patients with non-resolving pneumonia with special emphasis on efficacy of FOB and BAL in diagnosis.

Participants: Patients with non-resolving pneumonia aged over 18 years.

Study design: The study was conducted prospectively over a period of 24 months.

Methods:  A fiber optic bronchoscopy was done, the macroscopic apperance of bronchial tree was noted. In most patients various combinations of bronchial washings, bronchial brushing, endobronchial biopsy and trans-bronchial lung biopsy were carried out according to bronchoscopic findings.

Results: Out of total 70 subjects, 41 (58.6%) were males and 29(41.4%) were females. On CT Scan consolidation was present in 58 patients (83%), f/b consolidation with cavitation and consolidation with fibrosis. In this study Mycobacterium tuberculosis was found in 27 patients (38.6%), malignancy in 17 patients (24.3%), followed by bacterial pneumonia in 14 patients (20%), followed by fungal pneumonia in 5 patients (8.5%). Overall yield for fiber optic bronchoscopy was 91.4% with highest sensitivity of bronchoscopic specimens for mycobacterium tuberculosis.

Conclusions: Non resolving pneumonia is a great clinical challenge with diagonostic possibilities of both infectious and non-infectious causes. Although infections are most common causes of non- resolving pneumonias, malignancies should be considered particularly in smokers and elderly patients. Pulmonary tuberculosis should be considered an important cause of non- resolving pneumonia particularly in Indian population. Fiber optic bronchoscopy with BAL is a great utility tool in reaching the diagonosis of NRP. TBLB also adds a great value in reaching diagonosis in some patients particularly those having central mass lesions.