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