The Application of Bronchoalveolar Lavage in the Diagnosis of Chronic Eosinophilic Pneumonia-Two Case Report

支氣管肺泡沖洗術於診斷慢性嗜伊紅性肺炎的應用－二病例報告

許育彰(Yu-Chang Hsu) ； 王鴻昌(Hong-Chung Wang) ； 劉宜讓(I-Jan Liu) ； 陶宏洋(Hung-Yang Tao)

《胸腔醫學》 20卷6期 (2005/12) Pp. 619-626

https://doi.org/10.29806/TM.200512.0015

摘要

慢性嗜伊紅性肺炎是一種不常見且原因未明的疾病。這是一種亞急性的病症，特徵為血中嗜伊紅性血球過高、影像學檢查有兩側肺部週邊浸潤陰影、及對類固醇治療反應極佳。我們報告兩病例，有長時間咳嗽、呼吸困難、及發燒症狀，且有血中嗜伊紅性血球過多及血清嗜伊紅性陽離子蛋白濃度升高現象和影像學檢查有兩側肺部週邊浸潤病灶。他們不願意接受肺部組織切片檢查以尋求病因。於是我們為這兩位病人實施支氣管肺泡沖洗術，並發現於支氣管肺泡沖洗液中嗜伊紅性血球數目及嗜伊紅性陽離子蛋白濃度有升高的現象。這些發現是診斷慢性嗜伊紅性肺炎的要件。於是他們接受了類固醇治療並且於臨床上及影像學上有很迅速明顯的進步。支氣管肺泡沖洗液的分析對於此病的診斷提供了另一種有用的選擇並可避免不必要的手術危險。

關鍵字

支氣管肺泡沖洗術 ； 慢性嗜伊紅性肺炎

並列摘要

Chronic eosinophilic pneumonia (CEP) is an uncommonly idiopathic and subacute disease that is characterized by blood eosinophilia, peripheral pulmonary infiltrates on chest radiographs and prompt responses to corticosteroid therapy. We report 2 patients with non-productive cough, progressive dyspnea and prolonged fever, who had blood eosinophilia and an elevated level of serum eosinophilic cationic protein (ECP), and bilaterally peripheral pulmonary infiltrates on chest radiographs. Due to the fact that these patients were unwilling to receive open lung biopsy, bronchoscopy with bronchoalveolar lavage (BAL) was performed instead. Lavage fluid analyses showed increased numbers of eosinophils and elevated levels of ECP. These findings were consistent with the clinical diagnosis of CEP. Both patients received corticosteroid therapy and showed rapid clinical and radiographic improvement. BAL fluid analysis may provide an alternatively useful tool in establishing the diagnosis of CEP, and allows the patient to avoid certain surgical risks.

並列關鍵字

bronchoalveolar lavage ； eosinophilic cationic protein ； chronic eosinophilic pneumonia ； eosinophilia