Chest
Volume 102, Issue 1, Supplement, July 1992, Pages 32-37
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Bronchoalveolar Lavage Cell Findings in Patients with BOOP and Related Diseases

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BAL FLUID CELL FINDINGS IN PATIENTS WITH IDIOPATHIC BOOP

We studied 26 Japanese cases of idiopathic BOOP diagnosed by open lung biopsy specimen (Table 1). Clinicopathologic evaluation was done by Drs. Colby, King, Costabel, and our colleagues. Chest roentgenograms showed that alveolar opacities were found in 48% of the cases, interstitial opacities in 24%, and mixed opacities in 28%. Lavage was done at the middle lobe by using a physiologic saline solution 50 ml × 6 times. After filtering the lavage fuid through gauze, lavage cells were centrifuged

SERIAL EVALUATION OF LAVAGE CELL FINDINGS IN PATIENTS WITH BOOP

Considering the subacute onset and relatively good prognosis in patients with BOOP, a change in lavage cell findings may be in parallel with the disease activity. Therefore, a lavage was performed serially in 2 patients with BOOP (Fig 2). A significant increase in recovered cells, lymphocyte percent, and granulocyte percent, and a decrease in the ratio of CD4+/CD8+ was detected when abnormal chest roentgenograms were present. Subsequently, lavage cell findings returned to a normal range when

DIFFERENCES IN LAVAGE CELL FINDINGS BETWEEN BOOP AND IPF

Histologically, it is clear that BOOP differs from IPF(UIP),2 but sometimes we experienced that BOOP was confused with IPF clinically, because both presented a restrictive pulmonary dysfunction and interstitial changes on chest roentgenograms. As most patients with BOOP seem to respond well to treatment with corticosteroids,1 early recognition and diagnosis are important. Hence, we compared lavage cell findings in patients with BOOP and IPF(UIP) in order to be able to differentiate both

EVALUATION OF LAVAGE LYMPHOCYTOSIS IN PATIENTS WITH BOOP

Lavage cell findings in patients with BOOP strongly suggest a hyperimmune reaction in the lungs, as shown in cases of hypersensitivity pneumonitis (HP).4 Clinically, BOOP and HP are similar in terms of an acute or subacute clinical course and a good response to corticosteroids.

We examined 9 cases of idiopathic BOOP and 12 cases of HP (summer-type, humidifier-induced, bird-fancier). Lavage cell findings are shown in Figures 3 and 4. Both diseases showed similar findings, although recovered cells

COMPARISON OF EOSINOPHILS BETWEEN BOOP AND CHRONIC EOSINOPHILIC PNEUMONIA

Histologically, chronic eosinophilic pneumonia (CEP) shows a BOOP pattern.2 Clinically, it is difficult to differentiate BOOP from CEP, especially when presented cases are suspected of BOOP with multiple patchy migratory pulmonary involvements. To examine whether the number of eosinophils in patients with CEP is different from that in patients with BOOP, we compared BAL fluid cell findings of both diseases. Twenty-six cases of BOOP and 11 cases of CEP were compared clinically (Table 6).

DISCUSSION

Twenty-six Japanese cases of idiopathic BOOP were diagnosed by open lung biopsy specimen. As described by Colby et al,2 histopathologic findings in BOOP are nonspecific and may be seen in a number of pulmonary repair reactions: organizing infections, organizing diffuse alveolar damages, allergic reactions, drug reactions, collagen vascular diseases, organizing toxic exposures, eosinophilic pneumonia, eosinophilic granuloma, Wegener's granulomatosis, and other lesions, including abscesses and

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