대한흉부영상의학회 Weekly Chest Cases

Case No : 1480 Date 2026-03-02

Courtesy of Yunseong Kim, Ho Yun Lee / Samsung Medical Center
Age/Sex 65 / F
Chief ComplaintHoarseness, Xerostomia

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary alveolar proteinosis
Radiologic Findings: Fig 1. Chest radiograph shows patchy reticular opacitues at left lower lung field.
Figs 2-9. Chest CT shows multifocal crazy-paving appearance in both lungs with geographic distribution, predominantly in both lower lobes. The extent of lesion increased compared to chest CT obtained 3 years before.
Brief Review: Pulmonary alveolar proteinosis (PAP) may develop in a primary (idiopathic) form, chiefly during middle age, or less commonly in the setting of inhalational exposure, hematologic malignancy, or immunodeficiency. Current research supports the theory that PAP is the result of pathophysiologic mechanisms that impair pulmonary surfactant homeostasis and lung immune function. Clinical symptomatology is variable, ranging from mild progressive dyspnea to respiratory failure. There is a strong association with tobacco use.

* CT findings
- Crazy paving pattern (smoothly thickened septal lines on a background of widespread ground-glass opacity) with lobular or geographic sparing
* Radiologic differential diagnosis of crazy-paving
- Pulmonary edema, pneumonia, alveolar hemorrhage, diffuse alveolar damage, and lymphangitic carcinomatosis
* Diagnostic tool
- Lung biopsy or bronchoalveolar lavage revealing intraalveolar deposits of proteinaceous material, dissolved cholesterol, and eosinophilic globules
* Symptomatic treatment
- Whole-lung lavage (multiple procedures may be required)
References: 1. Frazier, A. A., Franks, T. J., Cooke, E. O., Mohammed, T.-L. H., Pugatch, R. D., & Galvin, J. R. (2008). Pulmonary alveolar proteinosis. RadioGraphics, 28(3), 883–899. https://doi.org/10.1148/rg.283075219
Keywords

No. of Applicants : 89

▶ Correct Answer : 11/89, 12.4%

- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
- , China FANG YING GEN
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Chonbuk National University Hospital , Korea (South) JUNGHOON OH
- , Japan KEISUKE OSHIMA
- , Japan SHUNJIRO NOGUCHI
- Matsunami General Hospital , Japan TARO TAKEDA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Correct Answer as Differential Diagnosis : 20/89, 22.5%

- Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
- Kyeongpook National University Hospital , Korea (South) JOHN BAEK
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- medical scanning , Japan HIROAKI ARAKAWA
- The University of Tokyo Hospital , Japan ISSEI FUKUDA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- , Japan HIROKI SAKURADA
- Kyoto University , Japan AKIHIKO SAKATA
- Central Hospital Atasehir Istanbul , Turkey ARMAGAN SARAC
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Osaka University , Japan AKINORI HATA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Nara Medical University , Japan AYA YAMADA
- Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
- Other , Korea (South) CHAEHUN LIM
- Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
- Etlik City Hospital, Ankara , Turkey MERIC TUZUN
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1480 Date 2026-03-02

Discussion

No. of Applicants : 89