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The Egyptian Journal of Bronchology
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Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies

Egyptian Journal of Bronchology volume 12, pages 340–345 (2018)Cite this article

Abstract

Rationale

Patients with hematological malignancies are a special challenge to health care providers as they undergo a wide variety of immune-suppressive therapies. Both disease and therapy can cause complications. The lungs may be directly injured through infectious or toxic insults. Early identification of the nature of infiltrates will result in better outcome in the management of these patients. Fiberoptic bronchoscopy (FOB) may be a good tool for indentifying the infiltrate nature by using different diagnostic techniques like transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL).

Patients and methods

This study was performed over 6 months, in Kasr Al-Aini Hospital, Cairo University. It included 30 patients with hematological malignancies presenting with pulmonary infiltrates confirmed by computed tomography of the chest. All patients underwent history taking, clinical examination, and investigations included complete blood count and coagulation profile, BAL for culture and sensitivity, cytology examination, and TBLB.

Results

Overall diagnostic yield of FOB was 73.3% in this study. The diagnostic yield of FOB was higher for infectious (43.3%) than both noninfectious (20%) and mixed (10%) etiologies. The combined diagnostic yield of BAL for bacteriological examination and TBLB was higher than that of BAL for cytology examination. Bacteriological examination revealed a predominance for gram-negative bacteria in 62.5% of total culture and sensitivity.

Conclusion

This study supports the role of FOB as the initial procedure of choice for identifying the nature of pulmonary infiltrates in patients with hematological malignancies. Because our results suggest that BAL and TBLB are complementary, we recommend performing TBLB whenever it is deemed safe. On the contrary, cytological examination of BAL fluids was not helpful in reaching a final diagnosis.

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Authors and Affiliations

  1. Pulmonary Medicine, Department of Pulmonary Medicine, Cairo University Hospitals, Kasralainy Street, 11562, Egypt

    Yosri Mohamed Kamel Akl, Reem Ibrahim Mohamed ElKorashy, Mohamed Said Ismail MD & Amir Kamal Morris Hanna

  2. Oncology Department, Cairo University, Egypt

    Hamdi Mohamed El Zawam

Authors
  1. Yosri Mohamed Kamel Akl
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  2. Hamdi Mohamed El Zawam
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  3. Reem Ibrahim Mohamed ElKorashy
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  4. Mohamed Said Ismail MD
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  5. Amir Kamal Morris Hanna
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Correspondence to Mohamed Said Ismail MD.

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Akl, Y.M.K., Zawam, H.M.E., ElKorashy, R.I.M. et al. Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies. Egypt J Bronchol 12, 340–345 (2018). https://doi.org/10.4103/ejb.ejb_107_17

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  • DOI: https://doi.org/10.4103/ejb.ejb_107_17

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