Insidious dyspnea + 'crazy paving' on HRCT, suspected pulmonary alveolar proteinosis
Recommended: HRCT Chest + BAL (milky / opaque fluid is diagnostic) is the preferred imaging study for insidious dyspnea + 'crazy paving' on hrct, suspected pulmonary alveolar proteinosis. Autoimmune PAP (anti-GM-CSF) is most common form.
Recommended study
HRCT Chest + BAL (milky / opaque fluid is diagnostic)
Autoimmune PAP (anti-GM-CSF) is most common form. BAL is diagnostic and therapeutic.
If the default doesn't apply
Severe / refractory
Whole-lung lavage
No contrast
Watch-outs
Mimics include drug toxicity / lipoid pneumonia
Crazy paving differential includes ARDS, pulmonary hemorrhage, lipoid pneumonia — clinical context essential.
Pearls
- Crazy paving = ground-glass + interlobular septal thickening in geographic pattern.
- Anti-GM-CSF antibody confirms autoimmune PAP.
- Treatment: whole-lung lavage, inhaled GM-CSF, plasmapheresis.