Presentation
Progressive dyspnea and dry cough.
Patient Data
Bilateral widespread and symmetric lung groundglass opacities, equivocal sparing of the apices. No pleural effusions. The cardiomediastinal contours are normal.
Widespread symmetrical groundglass opacities associated with inter and intralobular septal thickening give the crazy paving pattern. There is subpleural and equivocal costophrenic recess sparing. Airways are normal, no pleural effusion. The mediastinal structures are unremarkable, no lymphadenopathy.
The patient had complete bronchial/lung lavage on bronchoscopy.
Macroscopy: Bronchial washings - lightly, blood-stained fluid.
Microscopy: Smears show larger, acute inflammatory cells, alveolar macrophage, and background of PAS-positive proteinaceous material. Findings are in keeping with alveolar proteinosis.
Case Discussion
This case has been confirmed on bronchoscopy washings as pulmonary alveolar proteinosis, with further clinical improvement after the bronchoalveolar washing and corticoid treatment. Different from this case, this condition is typical to present in young and middle-aged adults (20-50 years of age).
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