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Alveolar Proteinosis: Multimedia

Author: Michael B Gotway, MD, Clinical Associate Professor of Diagnostic Radiology and Pulmonary/Critical Care Medicine, University of California at San Francisco School of Medicine; Consulting Staff, Scottsdale Medical Imaging, Ltd
Coauthor(s): Theodore J Lee, MD, Chief, Thoracic Radiology, San Francisco General Hospital; Assistant Professor of Clinical Radiology, University of California at San Francisco
Contributor Information and Disclosures

Updated: Dec 30, 2008

Multimedia

Frontal chest radiograph from a patient with pulm...
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Media file 1: Frontal chest radiograph from a patient with pulmonary alveolar proteinosis. This image demonstrates bilateral perihilar and infrahilar ground-glass opacity without evidence of mediastinal widening, pleural effusion, or adenopathy.
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Frontal chest radiograph from a patient with pulm...

Frontal chest radiograph from a patient with pulmonary alveolar proteinosis. This image demonstrates bilateral perihilar and infrahilar ground-glass opacity without evidence of mediastinal widening, pleural effusion, or adenopathy.

Frontal chest radiograph in a patient with pulmon...
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Media file 2: Frontal chest radiograph in a patient with pulmonary alveolar proteinosis. This image reveals bilateral air-space opacity without evidence of effusion or mediastinal widening. A faintly reticular pattern is present, representing thickened, interlobular septa.
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Frontal chest radiograph in a patient with pulmon...

Frontal chest radiograph in a patient with pulmonary alveolar proteinosis. This image reveals bilateral air-space opacity without evidence of effusion or mediastinal widening. A faintly reticular pattern is present, representing thickened, interlobular septa.

High-resolution computed tomography scan (window ...
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Media file 3: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with acute silicoproteinosis. This image demonstrates crazy paving, which refers to bilateral ground-glass opacity that is associated with marked interlobular septal thickening and a sharp nonanatomic demarcation between normal and abnormal lung.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with acute silicoproteinosis. This image demonstrates crazy paving, which refers to bilateral ground-glass opacity that is associated with marked interlobular septal thickening and a sharp nonanatomic demarcation between normal and abnormal lung.

Frontal chest radiograph in a patient with pulmon...
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Media file 4: Frontal chest radiograph in a patient with pulmonary alveolar proteinosis that was subsequently treated with bronchoalveolar lavage. This image reveals bilateral symmetric air-space opacity without pleural effusion or mediastinal widening.
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Frontal chest radiograph in a patient with pulmon...

Frontal chest radiograph in a patient with pulmonary alveolar proteinosis that was subsequently treated with bronchoalveolar lavage. This image reveals bilateral symmetric air-space opacity without pleural effusion or mediastinal widening.

Chest radiograph in a patient after bronchoalveol...
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Media file 5: Chest radiograph in a patient after bronchoalveolar lavage. This image demonstrates improvement in the bilateral air-space opacity. These opacities subsequently cleared completely, and the patient has remained in remission.
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Chest radiograph in a patient after bronchoalveol...

Chest radiograph in a patient after bronchoalveolar lavage. This image demonstrates improvement in the bilateral air-space opacity. These opacities subsequently cleared completely, and the patient has remained in remission.

High-resolution computed tomography scan (window ...
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Media file 6: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. The image reveals bilateral ground-glass opacity that is associated with septal thickening, which is consistent with the crazy-paving pattern.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. The image reveals bilateral ground-glass opacity that is associated with septal thickening, which is consistent with the crazy-paving pattern.

High-resolution computed tomography scan (window ...
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Media file 7: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis who received bronchoalveolar lavage. This image reveals regression of the ground-glass opacity, representing partial resolution of the disease.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis who received bronchoalveolar lavage. This image reveals regression of the ground-glass opacity, representing partial resolution of the disease.

High-resolution computed tomography scan (window ...
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Media file 8: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. This image demonstrates the presence of bilateral ground-glass opacity and interlobular septal thickening.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. This image demonstrates the presence of bilateral ground-glass opacity and interlobular septal thickening.

High-resolution computed tomography scan (window ...
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Media file 9: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis (PAP) (same patient as in Image above). This image reveals slight interval worsening of the bilateral ground-glass opacity and interlobular septal thickening that is consistent with progression of PAP.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis (PAP) (same patient as in Image above). This image reveals slight interval worsening of the bilateral ground-glass opacity and interlobular septal thickening that is consistent with progression of PAP.

High-resolution computed tomography scan (window ...
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Media file 10: High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. This image shows that the sharp demarcation between the normal and abnormal lung parenchyma that is characteristic of the crazy-paving pattern is less conspicuous than usual, although it is evident in the anterior segment of the right upper lobe. Ground-glass opacity that is associated with interlobular septal thickening is the dominant finding on this image.
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High-resolution computed tomography scan (window ...

High-resolution computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with pulmonary alveolar proteinosis. This image shows that the sharp demarcation between the normal and abnormal lung parenchyma that is characteristic of the crazy-paving pattern is less conspicuous than usual, although it is evident in the anterior segment of the right upper lobe. Ground-glass opacity that is associated with interlobular septal thickening is the dominant finding on this image.

Frontal chest radiograph in a patient with the di...
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Media file 11: Frontal chest radiograph in a patient with the diffuse form of bronchioloalveolar carcinoma. This image shows the presence of bilateral hazy, ground-glass attenuation, a normal mediastinal width, and no pleural effusion. This appearance resembles alveolar proteinosis.
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Frontal chest radiograph in a patient with the di...

Frontal chest radiograph in a patient with the diffuse form of bronchioloalveolar carcinoma. This image shows the presence of bilateral hazy, ground-glass attenuation, a normal mediastinal width, and no pleural effusion. This appearance resembles alveolar proteinosis.

Axial computed tomography scan (window width = 15...
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Media file 12: Axial computed tomography scan (window width = 1500 Hounsfield units [HU], level = -600 HU) in a patient with the diffuse form of bronchioloalveolar carcinoma. Note the presence of ground-glass opacity that is associated with septal thickening, resembling the crazy-paving appearance of alveolar proteinosis. The space-occupying nature of the process (note that the left major fissure is bowed posteriorly) and the lack of the usually sharp, but nonanatomic, demarcation between the normal and abnormal lung (best seen in the posterior right lung) are findings that are not characteristic of alveolar proteinosis and, thus, should suggest an alternative diagnosis.
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Axial computed tomography scan (window width = 15...

Axial computed tomography scan (window width = 1500 Hounsfield units [HU], level = -600 HU) in a patient with the diffuse form of bronchioloalveolar carcinoma. Note the presence of ground-glass opacity that is associated with septal thickening, resembling the crazy-paving appearance of alveolar proteinosis. The space-occupying nature of the process (note that the left major fissure is bowed posteriorly) and the lack of the usually sharp, but nonanatomic, demarcation between the normal and abnormal lung (best seen in the posterior right lung) are findings that are not characteristic of alveolar proteinosis and, thus, should suggest an alternative diagnosis.

Axial computed tomography scan (window width = 10...
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Media file 13: Axial computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with diffuse pulmonary hemorrhage. This image reveals diffuse, bilateral ground-glass opacity that is associated with mild interlobular septal thickening. Similar to Image 12, the lack of the sharp demarcation between the normal and abnormal pulmonary parenchyma, which is characteristic of crazy paving, suggests a diagnosis other than alveolar proteinosis. In addition, the septal thickening in alveolar proteinosis is usually more prominent.
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Axial computed tomography scan (window width = 10...

Axial computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) in a patient with diffuse pulmonary hemorrhage. This image reveals diffuse, bilateral ground-glass opacity that is associated with mild interlobular septal thickening. Similar to Image 12, the lack of the sharp demarcation between the normal and abnormal pulmonary parenchyma, which is characteristic of crazy paving, suggests a diagnosis other than alveolar proteinosis. In addition, the septal thickening in alveolar proteinosis is usually more prominent.

Axial computed tomography scan (window width = 1...
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Media file 14: Axial computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) obtained through the lower lobes in a patient with pulmonary edema. This image reveals the bilateral ground-glass opacity that is associated with smooth interlobular septal thickening. Although by definition these findings resemble crazy paving, the appearance is nevertheless quite distinct from alveolar proteinosis. Note also the absence of the sharp demarcation between the normal and abnormal lung that is usually a characteristic of crazy paving in alveolar proteinosis.
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Axial computed tomography scan (window width = 1...

Axial computed tomography scan (window width = 1000 Hounsfield units [HU], level = -700 HU) obtained through the lower lobes in a patient with pulmonary edema. This image reveals the bilateral ground-glass opacity that is associated with smooth interlobular septal thickening. Although by definition these findings resemble crazy paving, the appearance is nevertheless quite distinct from alveolar proteinosis. Note also the absence of the sharp demarcation between the normal and abnormal lung that is usually a characteristic of crazy paving in alveolar proteinosis.

A tube showing the milky-white bronchoalveolar la...
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Media file 15: A tube showing the milky-white bronchoalveolar lavage fluid from a patient with pulmonary alveolar proteinosis. Photo courtesy of Martha Warnock, MD.
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A tube showing the milky-white bronchoalveolar la...

A tube showing the milky-white bronchoalveolar lavage fluid from a patient with pulmonary alveolar proteinosis. Photo courtesy of Martha Warnock, MD.

More on Alveolar Proteinosis

Overview: Alveolar Proteinosis
Imaging: Alveolar Proteinosis
Follow-up: Alveolar Proteinosis
Multimedia: Alveolar Proteinosis
References
Further Reading
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Keywords

alveolar proteinosis, pulmonary alveolar phospholipoproteinosis, alveolar lipoproteinosis, PAP, surfactant protein, SP-B, granulocyte macrophage-colony stimulating factor, GM-CSF, bronchoalveolar lavage, BAL, whole-lung lavage, diffuse air-space disease

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Contributor Information and Disclosures

Author

Michael B Gotway, MD, Clinical Associate Professor of Diagnostic Radiology and Pulmonary/Critical Care Medicine, University of California at San Francisco School of Medicine; Consulting Staff, Scottsdale Medical Imaging, Ltd
Michael B Gotway, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Theodore J Lee, MD, Chief, Thoracic Radiology, San Francisco General Hospital; Assistant Professor of Clinical Radiology, University of California at San Francisco
Theodore J Lee, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey A Miller, MD, Associate Professor of Clinical Radiology, University of Medicine and Dentistry of New Jersey; Associate Chief of Service, Department of Radiology, Veterans Affairs of New Jersey Health Care System
Jeffrey A Miller, MD is a member of the following medical societies: North American Society for Cardiac Imaging, Society for Health Services Research in Radiology, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

John D Newell, Jr, MD, FACR, FCCP, FASER, Co-Director of Thoracic Imaging, UCDHSC; Director of Lung Imaging Center, Professor of Radiology and Professor of Medicine, Department of Radiology, University of Colorado Health Sciences Center, National Jewish Medical and Research Center; Univ. Colorado Hospital
John D Newell, Jr, MD, FACR, FCCP, FASER is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, American Thoracic Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Siemens Medical Grant/research funds Consulting; Forevision Technologies Ownership interest Consulting; Vida Corporation Ownership interest Board membership; TeraRecon Grant/research funds Consulting; eMedicine Honoraria Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Barry H Gross, MD, Professor, Department of Radiology, University of Michigan Medical School; Professor, University of Michigan Cancer Center
Barry H Gross, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Michigan State Medical Society, Physicians for Social Responsibility, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

 
 
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