Pulmonary alveolar proteinosis

Case contributed by Dr Bruno Di Muzio

Presentation

Dry cough in the last month.

Patient Data

Age: 40 years
Gender: Male

Bilateral widespread groundglass opacities associated with interlobular septal thickening and a few spared pulmonary lobules with normal attenuation giving the "crazy-paving" pattern, particularly within the lower lobes. No air-traping. No pleural effusion. No suspicious lymphadenopathy. 

Patchy ground glass opacities predominantly involving the mid and lower zones. No pleural effusions. 

Chest radiograph (2 months later)

Significant interval improvement with the lungs mostly clear and only some residual perihilar infiltrates. 

Case Discussion

This patient has had lung biopsy performed before being transferred to our institution. Both the biopsy and further bronchoalveolar lavage confirmed pulmonary alveolar proteinosis

The HRCT images show the classic crazy-paving pattern within the lower lobes. 

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