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Weekly Chest CasesArchive of Old Cases

Case No : 1431 Date 2025-03-24

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  • Courtesy of Se Ri Kang, Ji Young Rho / Wonkwang University Hospital
  • Age/Sex 47 / M
  • Chief ComplaintAbrnomal finding on health check up CXR
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary alveolar proteinosis
Radiologic Findings
Fig 1. Chest PA shows bilateral perihilar consolidation with sparing of the costophrenic angles and apices.
Fig 2, 3. CT scans reveals widespread ground glass opacity with multifocal areas of sparing and strikingly prominent spetal lines (crazy-paving pattern).
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
Keywords

No. of Applicants : 82

▶ Correct Answer : 68/82,  82.9%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , India ABNA J
  • - Ulsan University Hospital , Korea (South) SOYEOUN LIM
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - , United Kingdom SAMSON KADE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - , Italy PAOLO BALDASSARI
  • - , Japan CHIAKI SATO
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - Other , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Yonsei University,Severance Hospital , Korea (South) JUN GU KANG
  • - , Portugal JOAO PEDRO LIMA FERNANDES
  • - Other , Korea (South) KI-NAM LEE
  • - POST GRADUATE , India NALLAPATI LAKSHMI CHAITANYA
  • - , Japan JOJI KURASHIMA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Other , Korea (South) SEOL A LEE
  • - Holy Family Hospital , India RAJESH GOTHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - Kyoto University , Japan SHO KOYASU
  • - , Japan SHUHEI NORIMOTO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Samsung Medical Center , Korea (South) SEONGUK KIM
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Sweden MOHAMAD TLASS
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - , Chile YASSER AMAR SAPAJ
  • - , Japan JUN YOSHIDA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 6/82,  7.3%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) CHAEHUN LIM
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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