Bronchoalveolar Lavage in Interstitial Lung Diseases to Characterization of Specific Inflammatory Cellular Infiltrate in Different Interstitial Lung Diseases

"BAL is performed with the fiberoptic bronchoscope in a wedge position within the selected bronchopulmonary segment.~The total instilled volume of normal saline should be no less than 100 ml and should not exceed 300 ml.~Three to five sequentially instilled aliquots are generally withdrawn after each aliquot instillation.~For optimal sampling of distal airspaces, the total volume (pooled aliquots) retrieved should be greater than or equal to 30% of the total instilled volume.~A total volume of retrieved fluid less than 30% may provide a misleading cell differential, especially if total retrieved volume is less than 10% of total instilled volume.~If less than 5% of each instilled aliquot volume is recovered during the procedure due to retention of most of the fluid in the lavaged segment, the procedure should be aborted to avoid increased risk of tissue disruption and/or inflammatory mediator release due to overdistention of the lavaged segment."