AUBF 11

Expectoration

first morning; may require induction using 10%NaCl or propylene

brochoalveolar lavage

infusion of saline followed by aspiration using a bronchoscope

Red/bright red

recent hemorrhage (acute cardiac or pulmonary infarction, neoplasm invasion)

Rust-coloroed

decomposed hemoglobin (pneumococcal pneumonia)

Brown

congestive heart failure

Yellow/yellow green

presence of pus (pulmonary TB, chronic bronchitis)

Olive green/grass green

Chronic lung cancer

Black

dust particles, carbon or charcoal, heavy smokers, anthracosis

Cheesy masses

fragments of necrotic pulmonary tissue that range in size from pinpoint to pea-

size; seen in pulmonary gangrene, pulmonary TB, and lung abscess

Dittrich's plugs

yellowish or gray caseous materials about the size of a pinhead that emit a foul

odor when crushed; seen in bronchietasis, putrid bronchitis, and bronchial asthma

Pneumoliths/Broncholiths/Lung stones

small white or gray fragments from the calcification of infected and necrotic tissue within the bronchial cavity; seen in chronic PTB and histoplasmosis

Brochial casts

branching tree-like casts seen in lobar pneumonia and fibrincus bronchitis

Mycetomas

rounded masses of fungal elements seen in Aspergillus infection

Curschmann spirals

spirally twisted mucoid strands frequently coiled into little balls

Myelin globules

colorless, round or pea-shaped; not significant but may be mistaken for Blashtomyces spp.

Elastic fibers

refractile fibers shed off during the cougning out process; indicates destructive disease

Creola bodies

bronchial epithelial cells with vacuolated cytoplasm and ciliated borders

Carbon-laden or dust cells

contain black granules; seen in pneumoconiosis

Heart failure cells/siderophages

hemosiderin-laden cells seen in CHF and alveolar hemorrhage

Charcot Leyden crystals

hexagonal, needle-like or bipyramidal crystals; seen in bronchial asthma

Hematoidin

rhombic-shaped crystals; seen in pulmonary infarction and lung abscess

Sulfur granules

Actinomyces

Macrophages

- 56-80%

- Smoking-related interstitial lung disease, pulmonary Langerhans

cell histiocytosis, alveolar hemorrhage

Lymphocytes

- 1-15%

- Interstitial lung disease, drug reactions, pulmonary lymphoma nonbacterial infections, granulomatous lung disease, hypersensitivity pneumonitis or nonspecific interstitial pneumonia

* increased CD4/CD8: sarcoidosis or connective tissue disorders

* normal CD4/CD8: tuberculosis or malignancies

* decreased CD4/CD8: hypersensitivity pneumonitis, silicosis, drug-induced disease, or HIV infection

Neutrophil

- <3%

- Cigarette smokers, bronchopneumonia, toxin exposure, diffuse alveolar damage, acute lung injury, aspiration pneumonia, suppurative infection

Eosinophils

- 1-2%

- Asthma, drug-induced lung disease, infections (parasitic, mycobacterial, or fungal), hypersensitivity pneumonitis, and eosinophilic pneumonia

Mast cells

- <1%

- Hypersensitivity pneumonitis

Bronchial epithelial cells

- 4-17%

- Normal; more numerous in bronchial wash than in BAL specimens

Erythrocytes

Alveolar hemorrhage