Abstract Introduction Immunocompromised pediatric patients are particularly vulnerable to severe and often life threatening respiratory infections. Early and accurate diagnosis in this population is critical to prevent morbidity and mortality. Imaging plays an important role in guiding additional diagnostic workup such as bronchoalveolar lavage (BAL). This study focuses on understanding the correlation between nonspecific findings on chest computed tomography (CT) and clinical symptoms with bronchoscopy and BAL results. Methods Retrospective single center study was performed reviewing patients between 2019-2024, who underwent bronchoscopy. A total of 119 satisfied inclusion criteria, immunocompromised patients who had both BAL and chest CT. We reviewed bronchoscopy for comments on BAL and mucosal changes along with imaging findings on chest CT such as ground glass opacities, tree in bud, nodules, and multiple findings in immunocompromised pediatric patients. Descriptive statistical analyses were then performed using Microsoft Excel Version 2502 and Pearson’s Chi Squared test was performed using Simple STATA 13. Results Among the patients analyzed (n = 119), the most frequent imaging abnormalities were nodules (33%) and ground glass opacities (GGO) (32%). Mucosal evaluation during bronchoscopy revealed acute inflammatory changes were seen in 34% and chronic bronchitis features in 18 %. Regarding airway secretions, 33% had minimal secretions, 26% had significant secretions, 27% had none. BAL cultures were predominantly negative, being positive in 13% whereas BAL fungal cultures were positive in 7%. Among the cohort, fever was present in 47%, cough was reported by 52%, and sputum production was reported at 13%. There was no statistically significant correlation between patients with imaging abnormalities and positive BAL cultures when controlling for pretreatment with antibiotics prior to BAL. Discussion The predominance of ground glass opacities and nodular patterns indicates that diffuse and focal inflammatory processes were the most common radiologic manifestations. Presence of nodules or multiple abnormal findings on imaging had no statistically significant impact on positive culture results, even when corrected for pre-treatment with any medication. There was a low rate of culture positivity within this population that maybe secondary to noninfectious etiologies or culture negative infections. Together, these results emphasize the complementary roles of imaging and bronchoscopy in diagnostic workup and highlight the limited yield of culture-based microbiologic testing in this context. This abstract is funded by: none
Shroff et al. (Fri,) studied this question.