Diagnostic value of transbronchial lung biopsy in pulmonary alveolar proteinosis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the diagnostic value and limits of transbronchial lung biopsy (TBLB) in pulmonary alveolar proteinosis (PAP).@*METHODS@#The complete hospital data from Second Xiangya Hospital, Central South University, between June, 2006 and December, 2012, were analyzed retrospectively in 25 patients with PAP (who were diagnosed pathologically by TBLB or not by TBLB) and in 4 patients with other disease (who were misdiagnosed by TBLB).@*RESULTS@#Among the 25 patients with PAP, 14 patients were confirmed by TBLB in the fi rst time [TBLB positive rate in the first time was 56% (14/25)]; 6 patients who were misdiagnosed by TBLB in the fi rst time were confirmed by TBLB in the second time [the positive rate in the second time was 24% (6/25)]. Th e total positive rate was 80% (20/25). Th e total negative rate was 20% (5/25). Five patients with PAP, who showed negative results in TBLB analysis, were confirmed by the typical CT as well as the whole lung lavage. In addition, 4 patients with other diseases were misdiagnosed as PAP by TBLB.@*CONCLUSION@#TBLB is a very good diagnosis method. But the negative results in the first time cannot exclude PAP. TBLB should be repeated if conditions allow. If clinical manifestation and CT results are typical, it can be used for diagnosis of PAP combined with the positive results from bronchoalveolar lavage fluid check. However, for non-typical cases, it needs TBLB pathological diagnosis.

Crazy paving pattern caused by pulmonary alveolar proteinosis: CT findings and the pathologic basis / 中南大学学报(医学版)

OBJECTIVE@#To explore CT findings and pathologic basis of crazy paving pattern caused by pulmonary alveolar proteinosis.@*METHODS@#Twenty-four patients who were diagnosed pathologically as pulmonary alveolar proteinosis by transbronchial lung biopsy and bronchoalveolar lavage fluid from June 2006 to May 2012 were included in this retrospective study. All patients underwent a 64-slice CT of the lungs.@*RESULTS@#CT findings: crazy paving pattern was observed on CT imaging of all 24 patients. In 23 patients, crazy paving pattern displayed strip-shaped opacities with smooth edges, and there was a clear boundary between the pathological and normal lung tissues. The reticular opacities were connected with peripheral blood vessels and the branches were formed, and their diameters decreased slightly. Microscopically, hemangiectasis were seen in 17 patients.@*CONCLUSION@#Crazy paving pattern caused by pulmonary alveolar proteinosis displayed clear edges, and smooth reticular opacities, most of which were due to hemangiectasis of interlobular, interacinar and interalveolar septa. These findings of CT are helpful for the specific diagnosis of pulmonary alveolar proteinosis.

Lung MRI at 3T：comparison of CT and MRI in initial evaluation of pulmonary alveolar proteinosis / 中南大学学报(医学版)

Objective:To explore whether the phospholipidoproteinaceous material deposit within the alveoli by a high-ifeld 3T MRI has signal characters and its application for diagnosing pulmonary alveolar proteinosis.Methods:A total of 11 patients with pulmonary alveolar proteinosis previously diagnosed by ifberoptic bronchoscope lung biopsy underwent 64-slice helical CT scans and 3T MRI scans, and the CT scans and the MRI scans were compared. Results:hTe phospholipidoproteinaceous material deposit within the alveoli presented longer or equal T1 relaxation time and longer T2 relaxation time, without characters of fatty or deposits of protein-like substance signals and enhancement. The distribution, form, number and size of the lesions at T2WI were almost the same as those at CT, the lesions were irregular in morphology, and there was a clear boundary between the lesions and the adjacent normal lung tissues. Dynamic contrast-enhanced MRI showed thickened pulmonary arteriolae and venulae in the lesions with more obviously thickened pulmonary venulae, which were in conformity with the pulmonary artery and venule enhancement. CT scan in 1 out of the 11 cases showed lesions in both lungs mainly consisted of stripe-shaped and reticular structures, and no obvious sign of pulmonary alveolar proteinosis residue was found. MRI scan detected alveolar proteinosis that failed to be shown by CT scan. Conclusion:3T MRI T2WI can easily detect the lesions of long T2 signals formed by the lipoproteinaceous material deposit within the alveoli. In the lesions, geographic appearance was presented, and the crazy paving pattern was dimly visualized. MRI can relfect the morphological characters of PAP like CT and it is slightly better compared with CT in such aspects as evaluating the theraputic effect of lung lavage. As supplement to CT, high-field 3T MRI can serve as an important examination for lung diseases.

Characteristic CT findings and pathologic basis of ground glass opacity caused by pulmonary alveolar proteinosis / 中南大学学报(医学版)

OBJECTIVE@#To explore characteristic CT findings and pathologic basis of ground glass opacity caused by pulmonary alveolar proteinosis (PAP).@*METHODS@#Retrospective analysis of CT and pathological findings of 24 patients with PAP who were pathologically diagnosed from June 2006 to August 2011.@*RESULTS@#Findings with CT: the lesions of the 24 patients mainly presented ground glass opacities. Local consolidations were seen in 8 patients. In 23 patients part of ground glass opacities bordered strip-shaped opacities with smooth edges, and there was a clear boundary between them and the bordering normal lung tissues, presenting a geographic appearance. Lesions in the 5 cases were mixed with alveoli or lobule aerocele, which made ground glass opacities present curved edges. Crazy paving pattern was detected in the 24 patients. Microscopically, the alveoli were seen to be filled with floccules proteinaceous material in various quantities in the 24 patients; hemangiectasis and congestion were seen in 17 patients, and enlarged alveolar cavities were seen in 5 patients.@*CONCLUSION@#PAP usually causes ground glass opacities with clear edges, and different from ground glass opacities with obscure edges caused by other pulmonary diseases. They are relatively specific to the imagining diagnosis to PAP.