What is the role of bronchoalveolar lavage (BAL) in the diagnosis of Pneumocystis jiroveci pneumonia (PJP)?

Updated: Apr 24, 2019
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Bronchoalveolar lavage (BAL) is the most common invasive procedure used to diagnose P jiroveci pneumonia (PJP). It has a diagnostic yield that exceeds 90% (and may be higher if multiple lobes are sampled). [30] BAL yields a lower sensitivity in patients receiving aerosolized pentamidine, in which case a transbronchial biopsy may be performed in conjunction with BAL. [31]

Obtain BAL if PJP is strongly suspected and the induced sputum sample findings are negative. BAL may be used in patients who are unable to cooperate with an induced sputum sample (eg, because of altered mental status). BAL may be less useful in cases of suspected PJP relapse. Consultation with a pulmonologist is required for BAL.

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