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Bronchoscopy and Bronchoalveolar Lavage (BAL)
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Lab Tests

Bronchoscopy and Bronchoalveolar Lavage (BAL)

Bronchoscopy is a procedure used to examine and treat lung conditions, often paired with bronchoalveolar lavage (BAL) to collect fluid samples for diagnostic testing.

Overview

A bronchoscopy is a procedure used to check for the cause of a lung problem or to treat certain lung diseases. It utilizes a bronchoscope, a thin, lighted tube with a tiny camera, which is inserted through the nose or mouth into the airways. The tube can be flexible or rigid:

  • A flexible bronchoscope may be used to keep an airway open, remove secretions, or take a tissue sample (biopsy).
  • A rigid bronchoscope may be used to treat a tumor, manage bleeding, remove large obstructions, or insert a stent to assist with breathing.

Bronchoalveolar lavage (BAL), also called bronchoalveolar washing, is often performed during a bronchoscopy. A saline solution is passed through the bronchoscope to wash the airways and capture a fluid sample, which is then tested for infections or lung conditions.

What are they used for?

Bronchoscopy may be used to:

  • Find and treat growths or blockages in the airways
  • Remove lung tumors
  • Control airway bleeding
  • Investigate persistent lung symptoms, such as a chronic cough
  • Guide the placement of a breathing tube
  • Administer medication directly into the lungs
  • Determine the severity of diagnosed lung cancer

Bronchoscopy with BAL is specifically used to collect tissue for diagnosing conditions such as bacterial infections (including tuberculosis and bacterial pneumonia), fungal infections, and lung cancer.

Why do I need bronchoscopy and BAL?

These tests may be ordered if you experience symptoms such as a persistent cough, trouble breathing, or coughing up blood. They are also indicated if imaging tests, like a chest x-ray, reveal potential lung abnormalities. Individuals with immune system disorders, such as HIV or those who have received an organ transplant, may require these procedures for early diagnosis of lung infections.

What happens during bronchoscopy and BAL?

The procedure is typically performed by a pulmonologist. A bronchoscopy takes 30 to 90 minutes and generally involves the following:

  • You may be asked to wear a hospital gown and remove dental appliances.
  • You will lie on a bed or table with your head raised.
  • A sedative may be administered via an IV to help you relax.
  • A numbing medicine is sprayed into your mouth and throat.
  • The bronchoscope is inserted into your airways, allowing the provider to view the lungs on a video screen and perform necessary treatments.

During a BAL, a small amount of saline is passed through the bronchoscope into the airways and then suctioned back up, capturing cells and bacteria for laboratory analysis.

Preparation and Aftercare

You may need to fast for several hours before the procedure. Inform your provider about all medications you take, though you should not stop taking them unless instructed. After the test, your mouth and throat may remain numb for a few hours, so you must wait until the numbness subsides before eating or drinking. If you received a sedative, you will need someone to drive you home. You may experience a sore throat, cough, or hoarseness for a day or more.

Risks

While serious complications are rare, risks include bleeding in the airways, infection, or a pneumothorax (collapse of part of the lung).

What do the results mean?

Abnormal bronchoscopy results may indicate airway blockages, tumors, narrowing of the airways, or lung damage from immune disorders like rheumatoid arthritis. Abnormal BAL results may point to lung cancer or infections such as tuberculosis, bacterial pneumonia, or fungal infections. Your provider will interpret these results in the context of your medical history and symptoms.

Frequently Asked Questions

You must fast for at least 6 to 8 hours before the procedure to prevent aspiration, meaning you should not eat or drink anything after midnight if the test is scheduled for the morning. You will likely need to stop taking blood thinners or anticoagulants several days in advance, but only if your doctor explicitly instructs you to do so. It is also important to inform your care team about any allergies to medications, particularly local anesthetics or sedatives, and to arrange for a responsible adult to drive you home, as you will be drowsy from sedation for several hours after the procedure. What does the sensation of the procedure feel like, and how is the BAL fluid collection performed?::You will typically receive a numbing spray in your throat and a sedative through an IV to keep you relaxed and comfortable. While you may feel a urge to cough or a slight pressure in your chest, you should not feel sharp pain. During the BAL portion, the doctor inserts a small catheter into a specific lung segment and instills a small amount of sterile saline solution (usually 50 to 100 mL). You may feel a brief coughing fit or a sensation of fluid moving in your chest as the doctor gently aspirates the fluid back out for laboratory analysis. How long does it take to receive results from the BAL fluid, and what do abnormal findings indicate?::Preliminary results, such as a Gram stain or cytology, may be available within 24 to 48 hours. However, definitive results for bacterial, fungal, or mycobacterial cultures can take anywhere from 5 to 14 days, and some specialized tests for rare infections or genetic markers may take even longer. Abnormal findings might include the presence of specific pathogens like tuberculosis or fungi, malignant cells indicating lung cancer, or an elevated count of certain white blood cells that suggest conditions like hypersensitivity pneumonitis or eosinophilic pneumonia. Are there any specific risks associated with the saline wash during BAL that differ from standard bronchoscopy?::While the risks are generally low, the introduction of fluid can occasionally trigger a temporary drop in oxygen levels (hypoxemia) or a mild, self-limiting fever in the 24 hours following the procedure. In rare cases, the pressure used to instill the saline can cause air to leak into the chest cavity (pneumothorax) or lead to bleeding if the airway is inflamed. Your medical team will monitor your oxygen saturation closely during and after the wash to manage these potential complications immediately.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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