Il lavaggio broncoalveolare nelle malattie reumatiche

The rheumatic diseases are chronic immune-mediated disorders that share certain clinical characteristics, including inflammation of the joints, serosal membranes, connective tissue, and blood vessels in various organs. The lung is a particularly vulnerable target organ in these diseases because of its abundant vasculature and large amount of connective tissue. Several disease processes may cause pulmonary infiltrates in rheumatic disease patients. These include direct pulmonary involvement, infectious pneumonia, associated neoplasia, drug reaction. The differential diagnosis is a difficult task. To date a promising technique for studying pulmonary inflammatory processes is bronchoalveolar lavage (BAL). BAL allows one to examine the cellular and noncellular elements present on the epithelial surface of the alveolar space. BAL is particularly useful in rheumatic diseases when infection is being considered. Moreover, when performed in patients who are free of clinical pulmonary symptoms and have normal chest roentgenograms, BAL frequently shows subclinical alveolitis.