Pulmonary alveolar proteinosis

Case contributed by Mobeen Reza
Diagnosis certain


Transfer from outside hospital in ARDS, complaining of 2 month history of progressive dyspnea and productive cough refractory to outpatient therapy. 60 pack years of smoking. Worked for many years renovating old houses.

Patient Data

Age: 50 years
Gender: Male

Admission CT


Scattered ground-glass opacities, right greater than left, with interlobular septal thickening; representative of a crazy-paving pattern and suggestive of pulmonary alveolar proteinosis. 


PAS stains were positive for proteinosis. 

Post whole lung lavage


Repeat imaging status post whole lung lavage reveals marked improvement of ground glass opacities. 

Case Discussion

Right middle lobe bronchial washings were sent for PAS staining and returned positive for proteinosis. The patient subsequently underwent right whole lung lavage with 12 L of normal saline. 

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