Noninfectious Causes of Infiltrates
Radiation pneumonitis was an eventual diagnosis in five patients by open lung biopsy in two patients, autopsy in one, and clinical course in the remaining two. In three of these, BAL cytologic study demonstrated reactive atypia of epithelial cells consistent with radiation. In two other cases, the final diagnosis was rejection of transplanted lungs, and the “negative” BAL was clinically important in making this distinction. The BAL was also appropriately negative in two cases of adult respiratory distress syndrome and three cases of pneumonitis due to drug toxicity. Two cases of pulmonary infiltrates due to drug reaction responded quickly to corticosteroid therapy and drug withdrawal alone, while another with a skin rash as well cleared rapidly following discontinuance of the drug therapy. A patient with treated lymphoid interstitial pneumonia who subsequently developed adult respiratory distress syndrome had a “negative” BAL; autopsy showed difluse alveolar damage but no lymphoid interstitial pneumonia. A case of clinically disseminated Kaposis sarcoma was manifest in the lung by the presence of many hemosiderin-laden macrophages in the BAL fluid. One patient with pulmonary involvement by lymphoma, subsequently proven by lymph node biopsy, had an unremarkable BAL. Buy Asthma Inhalers Online
The pulmonary lesions were believed to be lymphoma because they were mass-like, occurred in a setting of disseminated (liver, spleen, lymph node) disease, and disappeared with chemotherapy directed against the lymphoma. Three cases of Hodgkins disease involving the lungs, malignant lymphoreticular cells, were present in the lavage.