Pulmonary alveolar proteinosis

Case contributed by Bruno Di Muzio


A few months history of progressive cough and dyspnea.

Patient Data

Age: 50 years
Gender: Male

CT Chest


There are multiple areas of "crazy paving" involving both lungs in a random distribution. The pleural spaces are clear. The airways are normal. No mediastinal or hilar lymphadenopathy. 

Case Discussion

Typical imaging features of crazy paving, which is a combination of: 

  • smooth thickening of interlobular and intralobular septal lines, and
  • groundglass opacities

This patient was submitted to bronchoalveolar lavage further confirming the diagnosis of pulmonary alveolar proteinosis: "Microscopy:  Smears showing acute inflammatory cells, alveolar macrophages, and background of PAS-positive proteinaceous material, all in keeping with alveolar proteinosis."

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