與大師對談許清寅主任

2019-04-16

64 Y/O WOMANPULMONARY ALVEOLAR PROTEINOSIS

Case 1

Brief history

• 64 y/o woman• PHx: none• Chief complain

– Cough off and on in recent months. CXR shows abnormal.

Imaging

• CXR• chest CT

• Crazy paving pattern:Ground-glass opacity with superimposed interlobular septal thickening and intralobular septal thickening

DDx:

• Acute respiratory distress syndrome (ARDS)• Pulmonary Hemorrhage• Pulmonary alveolar proteinosis• Pneumonia• Pulmonary edema

Acute respiratory distress syndrome (ARDS)

• ground-glass opacification• Dependent part consolidation

Pulmonary Hemorrhage

• Multifocal bilateral ground-glass opacities: Centrilobular, geographic, or diffuse• S/S:

– Dyspnea & nonproductive cough progresses– Hemoptysis– Fatique

• 80% of cases in children, typically < 10 years• Extremely rare: < 1 per million

Pulmonary alveolar proteinosis

• An abnormal intra-alveolar accumulation of surfactant-derived lipoproteinaceous material.

• Crazy-paving pattern• 90% autoimmune

Pulmonary alveolar proteinosisOther Essential Diagnosis strategy:

Bronchoalveolar lavage fluid• Milk like lavage fluid• PAS stain (+)

Clinical course

• Refer to Rheumatologist for survey => No conclusion.

• Symtomatic treatment• After 3 months follow CT, no obvious interval

change. • Patient lost follow up

Final diagnosis

• Acute respiratory distress syndrome (ARDS)• Pulmonary Hemorrhage• Pulmonary alveolar proteinosis• Pneumonia• Pulmonary edema