대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Chief Complaint

intermittent fever, chill, cough, sputum

Definitive Diagnosis

Pulmonary alveolar proteinosis

Past History

none

Reviewy

Abnormal intra-alveolar accumulation of surfactant-like material
positive to periodic acid Schiff (PAS) staining and rich in lipid
Middle aged adult, smoking associated
Radiograph
Symmetric, bilateral, relative sparing of apex and CP angle
CT
Crazy paving (scattered or diffuse GGA with interlobular septal thickening)
Remarkable intralobular septa expansion due to edema and dilatation of lymphatic system
Geographic distribution
D/Dx
Atypical pneumonia (PJP..), alveolar hemorrhage, bronchoalveolar carcinoma, lymphangitic carcinoma, ARDS
Tx: whole lung lavage
Superimposed infection (13%): Nocardia, Candida, Cryptococcus, Apergillus, MV, TB.

Keywords