Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration

Investigation of young children with severe recurrent wheeze: any clinical benefit?

“…Many individuals will have had trials of bronchodilators and inhaled steroids, and repeated blind trials may cause a delay in establishing an important diagnosis, such as upper airway obstruction or an endobronchial foreign body. Furthermore, for patients in whom aspiration is considered likely, bronchoscopy can provide additional information by measuring BAL neutrophils [17] and fat-laden macrophages [18]. It is important to note that the presence of some fat-laden macrophages in the BAL may be completely normal [19] and this is reflected in the present finding of a larger percentage of patients having fat-laden macrophages in BAL than the percentage with an abnormal pH study.…”

An Official American Thoracic Society Clinical Practice Guideline: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy

“…Findings consistent with pulmonary alveolar proteinosis should lead to an investigation of surfactant dysfunction mutations, GM-CSF pathway abnormalities, and lysinuric protein intolerance (80,(88)(89)(90)(91)(92)(93)(94)(95). Evidence of aspiration may be obtained by lipid staining of alveolar macrophages (96), although the sensitivity and specificity of the finding is questionable (97,98). Measuring gastric pepsin levels (99) and/or determining alveolar macrophage localization of milk proteins (100, 101) are more recently developed techniques, which are still undergoing study.…”

“…BAL may be useful for documenting the presence of blood or hemosiderin-laden macrophages in the lower respiratory tract (78), although this does not provide a specific explanatory diagnosis (103). The accuracy of BAL for the diagnosis of gastroesophageal reflux is the subject of debate, and several studies suggest that it is neither sensitive nor specific (97,98). Investigators have used BAL histologic studies to confirm abnormal cell markers in patients previously diagnosed with Langerhans histiocytosis (82,84), and inflammatory cytokine levels have been investigated in BAL fluid from patients previously diagnosed with sarcoidosis (85).…”

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

“…Three hamsters were used as naive controls (without tracheal instillation). Five animals from the PLGA and three of the saline groups were killed and underwent WLL on days 1,8,15,29,43, and 58 after tracheal instillation. The naive animals were killed on day 1, and WLL was performed.…”

“…The definite diagnosis of aspiration is not simple as the available tests such as barium swallow during videofluoroscopy and gastroesophageal scintigraphy are not sensitive enough for the diagnosis of aspiration (5). Also, the oil red O staining of alveolar macrophages, as suggested by Corwin and Irwin (6), has been shown to be nonspecific for the diagnosis of aspiration (7)(8)(9).…”