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

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

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

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1480 Date 2026-03-02

Discussion

No. of Applicants : 89