Lipid-laden alveolar macrophages (LLAM): A useful marker of silent aspiration in children

Abstract

At present there is no test available which identifies children suffering from silent aspiration due to gastroesophageal reflux (GER). The purpose of this study was to determine whether lipid‐laden alveolar macrophage (LLAM) scoring is a useful method to arrive at the diagnosis. We evaluated bronchoalveolar lavage fluid (BALF) from 68 children aged 6 months to 14 years (median 3.75 years) for the presence of lipid‐laden alveolar macrophages. We compared children with chronic chest disease (CCD) and GER to healthy surgical controls without known lung disease, and to children with recurrent pneumonia without GER. By grading the amount of intracellular Sudan Red‐positive material, we determined a semiquantitative lipid‐laden macrophage (LLAM) score for each patient. Patients with chronic chest disease suspected to be caused by silent aspiration secondary to GER had a significantly higher LLAM score (median, 117; range, 10–956) than children with recurrent pneumonia due to other reasons (median, 29; range, 5–127; P < 0.01) and healthy controls (median, 37; range, 5–188; P < 0.01). We believe that simply observing lipid‐laden macrophages is nonspecific, but quantitation of these cells is a useful method for diagnosing silent aspiration in children, especially when the score exceeds 200. Pediatr Pulmonol. 1999; 28:83–88. © 1999 Wiley‐Liss, Inc.

The Role of GERD Diagnosis and Treatment in Preventing Lung Function Decline After Pediatric Lung Transplantation

“…Considering that bronchoscopy is a common investigation in LuTx recipients, the presence of Sudanpositive cells in BAL has been suggested as a microaspiration indicator to detect GERD. [13][14][15] In our cohort, BAL was not sensitive enough to detect microaspiration. However, all patients in the fundoplication group had a positive BAL preoperatively, and negative results postoperatively, so it may be a useful indicator in severe cases.…”

Microaspiration in Infants with Laryngomalacia

“…Although in this study we found no significant difference between the mean LLMI in the BAL fluids of infants with laryngomalacia and in controls, 36% of infants with laryngomalacia had a positive LLMI, with more than 25% of the alveolar macrophages graded 3 and 4, suggesting episodes of microaspiration. Our results indicate that the diagnosis of microaspiration depends not only on calculating the LLMI, 6–8,10 but also on analyzing the number of cells in grades 3 and 4 (containing more than 50% lipid). LLMs graded 3 and 4 were absent in normal controls as well as children with respiratory diseases unrelated to aspiration 10 .…”

The effect of hyperbaric oxygen treatment on aspiration pneumonia

“…A standard diagnostic finding in lipoid pneumonia is the observation of macrophages (Ahrens et al 1999), which help in the diagnosis of chronic pulmonary aspiration (Bauer and Lyrene 1999;Umuroglu et al 2006). These findings suggested that multiple pulmonary aspirations of the enteral solutions studied resulted in chronic, rather than acute or subacute, histopathological changes.…”