equis - Articles
Lung: bronchoalveolar lavage
Introduction
- Cytology of fluids from the lower respiratory tract provides information about the condition of tissues next to the air spaces.
- To facilitate the diagnosis of lower airway disease.
- To evaluate airway cell populations.
Uses
- Investigation of pulmonary disease.
- Investigation of subclinical pulmonary disease, eg exercise intolerance.
- Diagnosis of severe equine asthma Equine asthma.
- Diagnosis of bacterial pneumonia Lung: pneumonia - bacterial.
Advantages
- Good correlation shown between bronchoalveolar lavage (BAL) cytology and pulmonary histopathology in individual horses.
- Quick and relatively simple technique, and can be performed in the field, provided there is good restraint.
- Cells are better preserved than in tracheal aspirate and cell populations have a narrower normal range making interpretation easier.
- Confirms that lung is source of poor performance.
- Equipment required is cheap.
Disadvantages
- Requires good restraint of horse, in particular of the head.
- Requires short-acting sedation Anesthesia: standing chemical restraint.
- Horse will cough throughout the procedure.
- Sample obtained tends to be from caudodorsal lung lobe, so may not be representative, eg if suspect aspiration pneumonia.
Technical problems
- Bacterial culture may be affected because of passage of endoscope through upper airways (compare with transtracheal aspiration Trachea: transtracheal aspiration / washing).
- Interpretation of results requires experience of technique and knowledge of other clinical findings.
- Iatrogenic trauma:
- Epistaxis can be minimized with good technique.
- Rarely pyrexia has been reported for up to 24 h following BAL.
Alternative techniques
- Transtracheal aspiration Trachea: transtracheal aspiration / washing (but poor correlation shown between results from this and BAL).
- Consider transtracheal aspiration if sample required for diagnosis of pleuropneumonia Lung: pleuropneumonia - bacterial (pleuritis).
- Tracheal wash via the endoscope Trachea: tracheal wash.
- Radiography Thorax: radiography.
- Endoscopy Respiratory: endoscopy.
- Lung function testing Lung: pulmonary function test.
Time required
Preparation
- 10 min.
Procedure
- 10-20 min.
Decision taking
Criteria for choosing test
- History of exercise intolerance, cough.
- Clinical signs consistent with lower airway disease.
- Endoscopic findings - mucus visible in airways
. - Radiographic findings - lung interstitial or bronchointerstitial patterns.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Koblinger K et al (2014) Bronchial collapse during bronchoalveolar lavage in horses is an indicator of lung inflammation. Equine Vet J 46 (1), 50-55 PubMed.
- Rendle D (2012) Making the most of samples from the equine respiratory tract - a clinician's perspective on clinical pathology. UK Vet 17, 4-9 VetMedResource.
- Barrelet A (2007) Laboratory investigation of poor performance in horses: Part 2 - Investigation of respiratory disease. UK Vet 12(1), 15-21 VetMedResource.
- Hoffman A M (1999) Bronchoalveolar lavage technique and cytological diagnosis of small airway inflammatory disease. Equine Vet Educ 11, 330-336 VetMedResource.
- Meyer T S, Fedde M R, Gaughan E M, Langsetmo I & Erickson H H (1998) Quantification of exercise-induced pulmonary hemorrhage with bronchoalveolar lavage. Equine Vet J 30 (4), 284-288 PubMed.
- Fogarty U & Buckley T (1991) Bronchoalveolar lavage findings in horses with exercise intolerance. Equine Vet J 23 (6), 434-437 PubMed.
- Derksen F J et al (1989) Comparison of transtracheal aspirate and bronchoalveolar lavage cytology in 50 horses with chronic lung disease. Equine Vet J 21 (1), 23-26 PubMed.
- Mair T S, Stokes C R & Bourne F J (1987) Cellular content of secretions obtained by lavage from different levels of the equine respiratory tract. Equine Vet J 19 (5), 458-462 PubMed.
Other sources of information
- McGorum B (2004) How to Perform a Bronchoalveolar Lavage in a Horse. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 234.