Bronchoscopy and Bronchoalveolar Lavage (BAL)

A Guide for Parents and Caregivers

What Is a Bronchoscopy?

A bronchoscopy is a procedure where a doctor uses a small camera to look inside your child’s airways. The airways are the tubes that carry air into the lungs. The camera lets doctors see these tubes up close.

There are two main types:

• Flexible bronchoscopy — A thin, bendable camera is passed through the nose or mouth and into the airways. Lung doctors (pulmonologists) do this type. It is the most common type used for children with chILD.
• Rigid bronchoscopy — A stiff metal tube is used to look at the larger, upper airways. Ear, nose, and throat (ENT) surgeons do this type. It is used to remove blockages or take tissue samples.

What to Expect Your child will be given medicine (sedation or anesthesia) so they sleep and feel no pain during the procedure. The procedure usually takes 30 to 60 minutes. Getting ready and waking up takes extra time. Your child should not eat or drink before the procedure. Your team will tell you exactly when to stop. Afterward, your child may cough more than usual for a short time. Their oxygen levels may be slightly low for a bit. Your child will be watched in a recovery area until they are fully awake and breathing well.

What Is a BAL (Bronchoalveolar Lavage)?

BAL stands for bronchoalveolar lavage. You may hear it called a “lung wash.”

A BAL is almost always done at the same time as a flexible bronchoscopy.

The doctor guides the camera to one part of the lung. They send in a small amount of clean salt water. The water flows deep into the tiny air sacs (alveoli — the spots where oxygen enters the blood). Then the doctor gently suctions the water back out. The water picks up cells and other material from deep inside the lungs. This fluid is sent to a lab for testing.

What the BAL Fluid Can Show

• Infections — bacteria, viruses, and fungi that may be causing or adding to the lung problem
• Immune cell patterns — the types and number of immune cells can point toward specific types of chILD
• Signs of aspiration — special cells can tell doctors if food or liquid has been getting into the lungs
• Other markers — the lab can run extra tests depending on what the team is looking for

Why a BAL Is Done for Children with chILD

• Many lung infections look just like chILD on an X-ray or CT scan. A BAL helps rule out infection.
• BAL results can help identify the type of chILD.
• It gives information that helps doctors decide on the best treatment.
• A BAL is much less invasive than a lung biopsy (surgery to remove lung tissue).

What Are the Risks?

A bronchoscopy with BAL is generally safe. But all procedures have some risk. Your care team will explain these before the procedure.

Common short-term effects after the procedure:

• More coughing than usual
• Oxygen levels slightly low for a short time
• Mild fever in the first day or two
• A small amount of blood-tinged mucus

Serious problems are not common but can happen. These include heavier bleeding, infection, or a reaction to the anesthesia.

When to Call Your Child’s Medical Team

Call your team if your child has:

• Trouble breathing that is getting worse
• A high fever
• Coughing up more than a small amount of blood
• Oxygen levels below their normal range

Questions to Ask Your Child’s Care Team

• What do you hope to learn from this bronchoscopy?
• Will a BAL be done at the same time?
• Who will give the anesthesia?
• How long will results take?
• What will the next step be based on the results?
• When can my child go back to normal activities?

Glossary

Alveoli — Tiny air sacs in the lungs where oxygen passes into the blood

BAL (Bronchoalveolar Lavage) — A “lung wash” used to collect cells and fluid from deep in the lungs

Bronchoscope — The thin, flexible camera used during bronchoscopy

chILD — Childhood interstitial and diffuse lung disease

Pulmonologist — A doctor who specializes in lung conditions

Sedation or anesthesia — Medicine that helps your child sleep or stay still and comfortable during a procedure

More Information — American Thoracic Society: Flexible Bronchoscopy

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This information is for educational purposes only. Always talk to your child’s doctor about your child’s care.