CT Features of Pulmonary Alveolar Proteinosis
J. Michael Holbert1,2,
Philip Costello3,
Wei Li4,
Robert M. Hoffman5 and
Robert M. Rogers5
1
Department of Radiology, University of Pittsburgh, St. Margaret, 815 Freeport
Rd., Pittsburgh, PA 15215.
2
Present address: Department of Radiology, Scott & White Memorial Hospital
and Clinic, 2401 S. 31st St., Temple, TX 16508.
3
Department of Radiology, Brigham & Women's Hospital, 75 Francis St.,
Boston, MA 02215.
4
Department of Biostatistics, Graduate School of Public Health, University of
Pittsburgh, Pittsburgh, PA 15261.
5
Department of Pulmonary, Allergy and Critical Care Medicine, University of
Pittsburgh, Montefiore, G-Level, 3459 Fifth Ave., Pittsburgh, PA 15213.
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Fig. 1. —38-year-old man with pulmonary alveolar proteinosis. CT image
(1-mm section) shows that right lung has geographic pattern of disease,
whereas left lung has diffuse pattern. Asymmetric patterns in same slice are
not unusual.
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Fig. 2A. —39-year-old woman with pulmonary alveolar proteinosis
presenting as widespread bilateral air-space disease in geographic pattern. CT
images (1-mm sections) show that disease severity is nearly uniform from top
to bottom of lungs. Scan obtained at level of aortic arch.
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Fig. 2B. —39-year-old woman with pulmonary alveolar proteinosis
presenting as widespread bilateral air-space disease in geographic pattern. CT
images (1-mm sections) show that disease severity is nearly uniform from top
to bottom of lungs. Scan obtained at level of carina.
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Fig. 2C. —39-year-old woman with pulmonary alveolar proteinosis
presenting as widespread bilateral air-space disease in geographic pattern. CT
images (1-mm sections) show that disease severity is nearly uniform from top
to bottom of lungs. Scan obtained at level of inferior pulmonary veins.
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Fig. 3A. —38-year-old man with pulmonary alveolar proteinosis
presenting as widespread bilateral ground-glass opacities with superimposed
interlobular opacities on CT images (1-mm sections). Scan obtained at level of
aortic arch. Note no interlobular opacities are visible.
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Fig. 3B. —38-year-old man with pulmonary alveolar proteinosis
presenting as widespread bilateral ground-glass opacities with superimposed
interlobular opacities on CT images (1-mm sections). Scan obtained at level of
carina shows widespread interlobular opacities.
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Fig. 3C. —38-year-old man with pulmonary alveolar proteinosis
presenting as widespread bilateral ground-glass opacities with superimposed
interlobular opacities on CT images (1-mm sections). Scan obtained at level of
inferior pulmonary veins shows slightly more interlobular opacities at lung
bases.
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Fig. 4. —38-year-old man with pulmonary alveolar proteinosis. CT image
(1-mm section) shows air-space opacities in dependent portions of lungs
(thick arrows). Ground-glass opacities are present (thin
arrows) with some sparing of anterior lungs. Widespread interlobular
opacities (arrowheads) are superimposed bilaterally.
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Fig. 5A. —41-year-old woman with pulmonary alveolar proteinosis.
Magnified view of CT image (1-mm section) of right upper lobe shows geographic
involvement with areas of spared lung (long arrows). Crazy paving
pattern (arrowheads), combining smooth interlobular opacities and
ground-glass opacities, is visible. Network of fine, lacy intralobular
opacities is superimposed over regions of ground-glass opacity and is better
seen posteriorly (short arrow).
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Fig. 5B. —41-year-old woman with pulmonary alveolar proteinosis. CT
image of right upper lobe obtained 15 mm lower than A shows similar
findings of areas of spared lung (long arrows), crazy paving pattern
(arrowheads), and intralobular opacities (short arrows).
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Fig. 6A. —53-year-old man with history of pulmonary alveolar
proteinosis who developed Nocardia pulmonary abscess and
Nocardia osteomyelitis of three right ribs. Patient underwent right
middle and lower lobe bilobectomy and partial right chest wall resection. CT
image obtained at level of aortic arch (1-mm section) reveals severe bilateral
pulmonary fibrosis, which is worse on left, with honeycombing, distortion, and
traction bronchiectasis. Postoperative changes after bilobectomy are
visible.
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Fig. 6B. —53-year-old man with history of pulmonary alveolar
proteinosis who developed Nocardia pulmonary abscess and
Nocardia osteomyelitis of three right ribs. Patient underwent right
middle and lower lobe bilobectomy and partial right chest wall resection. CT
image obtained 3 cm below carina (1-mm section) confirms widespread pulmonary
fibrosis and shows further postoperative changes.
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Fig. 7A. —39-year-old woman with pulmonary alveolar proteinosis. CT
image (1-mm section) obtained a few days before bilateral whole-lung lavage
shows extensive bilateral ground-glass and interstitial opacities. Some
air-space opacities are visible in posterior lung bases.
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Fig. 7B. —39-year-old woman with pulmonary alveolar proteinosis. CT
image obtained 3 weeks after lavage shows lungs are almost completely
clear.
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Copyright © 2001 by the American Roentgen Ray Society.
