In short: In bronchoscopy, a thin, flexible tube is passed into the airways under sedation to look at them from the inside and take samples. BAL (bronchoalveolar lavage) is a wash of part of the lung with sterile fluid, which is collected back and sent for testing. It is one of the most accurate ways to diagnose an infection, inflammation or tumour.
Why bronchoscopy is done
- Investigation of a suspicious finding or nodule on CT, and taking a biopsy
- Staging of lung cancer, including ultrasound-guided sampling of chest lymph nodes (EBUS)
- Pneumonia that does not resolve, or recurrent pneumonia in the same place
- Chronic cough with sputum, when sputum cultures have not given an answer
- Suspected tuberculosis or nontuberculous (atypical) mycobacteria
- Lung infection in people with a weakened immune system
- Blood in the sputum
- Interstitial lung disease, when further diagnostic work-up is needed
- Clearing secretions or mucus plugs, and removing a foreign body
BAL: a lung wash to investigate infection and inflammation
During the procedure, sterile saline is instilled in small portions into a specific area of the lung and suctioned back. The fluid contains cells and microorganisms from deep in the lung, which makes it more accurate than coughed-up sputum.
- Cultures for bacteria, fungi and mycobacteria (including tuberculosis)
- Molecular tests (PCR) for viruses and bacteria
- Cell count: for example, an excess of lymphocytes or eosinophils points towards certain types of interstitial lung disease
- Cytology for abnormal cells
The procedure
The procedure is performed on an outpatient basis at Assuta Hospital, under sedation and with continuous monitoring of heart rate, blood pressure and oxygen. The bronchoscope is introduced through the mouth or nose. The procedure itself usually takes 20 to 40 minutes, followed by a short period of observation until you are fully awake.
How to prepare
- Fast for 6 hours before the procedure
- Let us know in advance if you take blood thinners or antiplatelet medication. Do not stop them without instructions
- Bring previous imaging studies and a list of your medications
- Come with a companion. After sedation you must not drive until the following day
After the procedure
Do not eat or drink for about two hours, until the local anaesthetic numbness in the throat wears off. In the first few days you may have a sore throat, cough, a small amount of blood in the sputum or a mild fever. After a lung biopsy there is a small risk of pneumothorax (collapsed lung). If high fever, shortness of breath or chest pain develop, inform the medical team immediately.
When the results arrive
Preliminary results are available within a few days. Cultures for mycobacteria may take several weeks. We will go over the results together at a follow-up appointment.
Frequently asked questions
Does it hurt?
The procedure is done under sedation, and most patients do not remember it. Afterwards there may be a sore throat and a mild cough for a day or two.
Why isn't a sputum culture enough?
Sputum passes through the mouth and throat and becomes contaminated with bacteria from them. With BAL the sample is taken directly from the affected area, so it is more accurate, especially when the first treatment has not worked.
Related topics
General information only; it does not replace a medical consultation. עברית