Cytology of the Respiratory System Especially Bronchoalveolar Lavage

Through the development of patient-friendly endoscopic techniques, diagnostic lavage (with 10-30 ml physiological saline solution) and its cyto-logical workup are now in widespread use. This method is briefly mentioned here because of its broad interest for all medical professionals with an interest in morphology; the interested reader is referred to the specialist literature (e.g. Costabel, 1994) for further information. Table 31 lists the most important indications for bronchoalveolar lavage.

Table 31 Clinical indications for bronchoalveolar lavage (according to Costabel 1994)

Interstitial infiltrates

Alveolar infiltrates

Pulmonary infiltrates in patients with immune deficiency

Sarcoidosis (Boeck disease)


HIV Infection

Exogenous allergic alveolitis

Alveolar hemorrhage

Treatment with cytostatic

Drug-induced alveolitis

Alveolar proteinosis


Idiopathic pulmonary fibrosis

Eosinophilic pneumonia

Radiation sickness

Collagen disease

Obliterating bronchiolitis

Immunosuppressive therapy

Histiocytosis X

Organ transplant


Lymphangiosis carcino-


Accessible cysts (e.g., branchial cysts) should be aspirated. Bronchial lavage is a cytological new discipline

Bronchial Lavage Cells Pictures

Fig. 66 Cyst biopsy and bronchoalveolar lavage. a Cytology of a lateral neck cyst: no lymphatic tissue, but epithelial cells from the floor of the mouth. b Normal ciliated epithelial cells with typical cytoplasmic processes. c Tumor cell conglomeration in small-cell bronchial carcinoma: conglomeration is typical of tumor cells. d Bronchoalveolar lavage in purulent bronchitis: a macrophage with pigment inclusion (arrow) is surrounded by segmented neutrophilic granulocytes.

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