Pneumology in COVID-19 times: facing misleading diagnosis

Introduction: COVID-19 diagnosis is established on the basis of clinical findings, compatible radiography and the determination by PCR of the presence of SARS-CoV-2 virus genetic material or its antigens in the respiratory tract, being the bronchoalveolar lavage (BAL) the sample which offers best results. The aim of this work is to study BAL diagnostic utility in patients with suspected COVID-19, who have had a negative SARS-Cov-2 PCR result with nasopharyngeal swab. Methods: An observational, descriptive and retrospective study was conducted in patients with clinical and radiographic findings compatible with COVID-19 who have had a negative SARS-CoV-2 result with nasopharyngeal swab. A bronchoscopy was performed to analyse PCR of SARS-CoV-2 with BAL. Results: From 06/03/2020 to 19/01/2021, 36 bronchoscopies were performed on 36 different patients (23 males [63.89%], average age of 40 years [22-89]). 27 were held in endoscopy room and 9 in ICU. PCR for SARS-CoV-2 with BAL was positive in 8 patients, establishing the diagnosis of COVID-19. The diagnosis of the remaining 28 patients is reflected in Figure 1. There were no serious complications associated with the procedure. 6 patients died during the admission. Conclusions: The performance of a BAL in patients with suspected COVID-19 and a negative SARS-CoV-2 PCR result with nasopharyngeal swab is a safe procedure, being a useful tool to confirm the disease and to advance the diagnosis in the rest of cases.