Summary:Bronchoalveolar lavage (BAL) has proved valuable in the diagnosis of pulmonary complications in immunosuppressed patients. We evaluated the diagnostic yield of BAL in pulmonary complications in bone marrow transplantation (BMT) recipients. We reviewed sequentially the records of 89 patients during an 18-month period. BAL was diagnostic in 42 patients (47%). The most common pulmonary complication diagnosed by BAL was diffuse alveolar hemorrhage (n ‫؍‬ 15); followed by bacterial pneumonia (n ‫؍‬ 10), respiratory syncytial virus (n ‫؍‬ 8), aspergillosis (n ‫؍‬ 6), Pneumocystis carinii pneumonia (n ‫؍‬ 5), cytomegalovirus (CMV) (n ‫؍‬ 4), and others (n ‫؍‬ 4). The final diagnoses in the BAL nondiagnostic group were: bacterial pneumonia (n ‫؍‬ 6), CMV (n ‫؍‬ 6), idiopathic pneumonia syndrome (n ‫؍‬ 5), cancer recurrence (n ‫؍‬ 4), cardiogenic pulmonary edema (n ‫؍‬ 4), and others (n ‫؍‬ 9). We conclude that BAL is a useful diagnostic tool in BMT-related pulmonary complications. Bone Marrow Transplantation (2000) 25, 975-979. Keywords: bone marrow transplantation; bronchoalveolar lavage; bronchoscopy; lung diseases; fiber optics Pulmonary complications occur in recipients of bone marrow transplantation (BMT) due to toxicity of the conditioning regimen, and to infections related to the post-transplant immunodeficiency and graft-versus-host disease.1-4 These pulmonary complications constitute the major cause of morbidity and mortality in immunosuppressed patients. [5][6][7] It is generally accepted that the earlier the etiology is recognized the better the outcome. 2,8Fiberoptic bronchoscopy (FOB) is the most frequently used tool in the diagnosis of pulmonary complications in BMT patients.6,9-16 However, it is frequently not possible to obtain a biopsy because of concomitant thrombocytopenia. Then, FOB is limited to bronchoalveolar lavage (BAL). 17,18 Several studies have established a diagnostic yield from 20% to more than 65%, and complication rates from 0 to 27%. 1,3,6,[8][9][10]12,16,18,19 We reviewed results of FOB with BAL in 89 BMT patients in order to assess the diagnostic Patients and methodsWe sequentially reviewed the records of 89 patients at MD Anderson who underwent FOB with BAL as part of their diagnostic work-up for pulmonary complications following BMT (either allogeneic or autologous) during an 18 month period.The main indication for BAL was the development of new pulmonary radiographic infiltrates. FOB was performed using a conventional technique. Because our patients frequently have some degree of thrombocytopenia, the oral route was preferred due to its lower risk of bleeding compared with the nasal route. The fiberoptic bronchoscope was wedged into a subsegmental bronchus, and four to six 20 ml aliquots of sterile normal saline were instilled and retrieved using a syringe. BAL fluid was then sent for cytologic and microbiologic examinations that included: gram stain and culture, acid-fast bacilli stain and culture, fungal stain and culture, methenamine silver stain, direct fluorescence ant...

Non-traumatic vascular complications affecting the lower limbs include endofibrosis, stenosis/kinking of iliac arteries, dissection of external iliac artery, adductor canal syndrome, popliteal entrapment syndrome, chronic exertional compartment syndrome and effort-induced venous thrombosis. These are important as they affect athletes at the peak of their career and can be confusing to diagnose. The management is relatively well documented and produces good results in short term but the long term results are not known.

The 'extension technique' has been found to be a safe and effective procedure for prevention of DASS, with a good patency rate. Additional advantage of this technique is maturation of both cephalic and basilic veins.

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