Bronchoalveolar Lavage-induced Pneumothorax

19 Feb

Bronchoalveolar Lavage-induced PneumothoraxFiberoptic bronchoscopy (FOB) is associated with various complications, including cough, bronchospasm, and hypoxia. Pneumothorax has been known to occur following FOB when transbronchial, brush, or endobronchial biopsies are performed. Complications associated with bronchoal-veolar lavage (BAL) include fever, pneumonitis, bleeding, stridor, and bronchospasm. Use of FOB with BAL alone has, to our knowledge, not been reported to result in pneumothorax. The purpose of this report is to consider that patients with pneumonia as a result of the destructive nature of the inflammatory process are predisposed to developing pneumothorax as a complication of BAL. canadian drug mall

Case Report
A 32-year-old woman with a history of intravenous (IV) drug abuse was admitted with weight loss, fever, and chills. On admission, her temperature was 38.1°C; heart rate, 106 beats/min; respiratory rate 20/min; and blood pressure, 116/80 mm Hg. Diffuse adenopathy— cervical, axillary, and inguinal—was evident on palpation. Result of a chest examination was normal, and a chest x-ray film showed bilateral interstitial infiltrates. A gallium lung scan showed bilateral increased uptake. The FOB with BAL, using 100 ml of 0.9 percent sterile saline solution inserted into a subsegmental bronchus of the right middle lobe, yielded a 40 percent return, with Pneumocystis carinii identified on smear. The severity of the cough accompanying the procedure was estimated as mild to moderately severe. Fifteen minutes after BAL, the patient complained of right-sided chest pain and cough. Chest x-ray film revealed a right-sided pneumothorax, which resolved following intercostal catheter placement. Serum was positive for HIV by both the enzyme linked immunosorbent assay (ELISA) and Western blot methods. She was diagnosed as having AIDS: group TV, C-l.