bronchoalveolar lavage ( bal ) is a saline wash of the bronchial tree introduced in 1970 . it is an investigative technique . it became a diagnostic tool in india in 1994 . we take this opportunity to highlight the utility of bal material in making a definite diagnosis . it is a relatively safe procedure and is well tolerated . with the number of conditions that can be diagnosed , we strongly suggest that bal should be used as a diagnostic tool and just not an investigating procedure . american thoracic society guidelines for clinical practice has given the normal ranges for healthy adult nonsmokers . bronchoalveolar lavage was done in patients where clinical , radiological and routine laboratory investigations did not clinch a diagnosis . bronchoalveolar lavage was obtained in 91 cases over 1 year period that is january 2012 to jun 2013 . procedure was done under sterile conditions using 5 mm flexible fiber optic bronchoscope after spraying 10% lignocaine locally . bal aliquots of 20 ml 0.9% saline were used via syringe and a total of 120 - 150 ml was used . suction of 100 mm of water was applied and about 70% of total instillate was retrieved . this fluid was sent to the lab in different containers for total and differential counts , cytology and microbiological examinations . stains for acid fast bacilli ( afb ) were done on all bal samples , and fungal stains were done when there was a clinical and cytological suspicion and in all samples from immunosuppressed patients . adequacy of samples was assessed based on definite criteria . ciliated columnar cells of more than 5% was indicative of contamination and not representative . the criteria are - 
 paucity of alveolar macrophages < 10/10 hpfs.extensive epithelial cells.mucopurulent exudates.numerous red blood cells.degenerating changes . age of patients ranged from 12 years to 82 years ; 66 were males and 25 were females . we diagnosed tuberculosis in 22 cases , malignancy in 13 cases , fungal infection in 7 cases and 38 bacterial infections . out of 38 bacterial infections [ table 2 ] klebsiella was the commonest organism isolated ( 39% ) , followed by pseudomonas in 23% , acinetobacterium was grown in 13% cases , escherichia coli in 15% and methicillin - resistant staphylococcus aureus , in 7.8% cases . afb were seen in 22 cases , and bacterial load varied from patient to patient . out of 13 malignancies four were adenocarcinomas , five squamous cell carcinomas [ figure 1 ] two small cell carcinomas and two poorly differentiated carcinomas . there were seven fungal lesions ; 4 cases had candida , two of these also had coexisting afb . . we could not give a definite diagnosis in 7 cases where there was a mixed inflammatory infiltrate , afb and fungal stains were negative , and cultures were negative . distribution of cases based on cytological diagnosis distribution of the cases based on bacteria isolated septate branching hyphae ( gms 400 ) neoplastic cells diffusely scattered and alveolar macrophages ( h and e , 400 ) bal as a diagnostic tool can be used to accurately diagnose various infections and also obtain material for culture and sensitivity . bal samples the epithelial lining of alveoli and hence rate of detection of tuberculosis is more . patients with positive tuberculin test and abnormal chest radiographs pose a diagnostic dilemma to clinicians . bronchoscopy is useful in such cases to obtain lavage , where other modalities are not contributory . in a study by baughman,87% of bronchoscopy specimens we did fungal stains in lavages from immunosuppressed patients and when there is clinical or cytological suspicion . in fungal lesions , morphological analysis on gomori 's methenamine silver stained smears helps in diagnosing various fungi . the diagnosis of neoplastic lesions of the lung is a diagnostic problem for pulmonologists because some malignant lesions mimic infectious or inflammatory conditions . in such a clinical setting , bal has a relevant role in detecting neoplastic cells or can also rule out malignant lesions . the role of bal is based on growth pattern , cytological characteristics and correlation of morphology with imaging features and diagnostic value added by new investigations . levy et al . compared the yield of various diagnostic procedures and concluded that yield of bal was high ( 66% ) as compared to washings ( 57% ) , brushings ( 40% ) , transbronchial biopsy ( 44% ) . bronchoalveolar lavage is insufficient to diagnose the specific type of interstitial lung diseases ( ilds ) . in addition therapeutic uses of bal , include removal of tenacious mucous plugs in asthma and cystic fibrosis . various soluble constituents like cytokines or other inflammatory mediators and collagen metabolism markers are used for research purpose . bronchoalveolar lavage is a useful diagnostic tool in diagnosing bacterial pneumonias , tuberculous lesions , fungal infections , and malignancies . the number of lesions with a definite diagnosis outnumber the lesions that can not be diagnosed hence we opine that bal is a useful diagnostic modality not only for routine diagnosis , but also for ancillary techniques and research purpose .
introduction : bronchoalveolar lavage ( bal ) is a diagnostic procedure by which cells and other components from bronchial and alveolar spaces are obtained for various studies . 
 one of the main advantages of bal is that it can be done as a day care procedure . 
 material obtained by bal can give a definite diagnosis in conditions such as infections and malignancies.aims:the aims and objective of this study were to assess the utility of bal as a diagnostic tool to determine the diagnostic accuracy of the material obtained from bal in various infections and neoplastic lesions to study the limitations of bal in certain lung disorders.materials and methods : this study was done in a tertiary care center in hyderabad . 
 bronchoscopy was done as an outpatient procedure and lavage fluid obtained analyzed . 
 this is a prospective study done from january 2012 to jun 2013 . 
 ninety - one bals were analyzed for total and differential count , microbiological examination and cytological evaluation . 
 cases selected included nonresolving pneumonias , diffuse lung infiltrates , infiltrates in immunosuppressed hosts and ventilator - associated pneumonias.results:bronchoalveolar lavage was done in 91 cases over a period of 1 years . 
 definite diagnosis was not given in 7 cases . 
 four cases were inadequate . 
 tuberculosis was diagnosed in 22 cases , fungal infections in 7 cases . 
 thirty - eight cases of bacterial pneumonias were diagnosed , klebsiella was the most common organism . 
 malignancy was diagnosed in 13 cases.conclusion:definite diagnosis can be made in tuberculosis , fungal infections , bacterial pneumonias and in malignancies .