Bronchoscopic lung cryobiopsy for the diagnosis of pulmonary alveolar proteinosis in a hypoxemic patient

• Main Authors: Vikas Marwah, C D S Katoch, P Sengupta, Saikat Bhattacharjee
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Lung India
• Subjects: bronchoscopic cryobiopsy; pulmonary alveolar proteinosis; whole lung lavage
• Online Access: http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=4;spage=336;epage=339;aulast=Marwah
• ISSN: 0970-2113; 0974-598X

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the intra-alveolar accumulation of surfactant due to macrophage dysfunction or the production of abnormal surfactant. Diagnosis is usually confirmed by lung biopsy either bronchoscopically or by video-assisted thoracoscopic surgery. Bronchoscopic lung cryobiopsy (BLC) is increasingly being utilized for the histopathological diagnosis of diffuse parenchymal lung diseases; however, it has rarely been reported for PAP. We report a case of 59-year-old male who presented to our center with gradually worsening breathlessness and cough of 1-year duration. Chest radiograph revealed bilateral extensive pulmonary infiltrates and high-resolution computerized tomography scan revealed extensive bilateral ground-glass opacities with areas of sparing. BAL and transbronchial lung biopsy failed to confirm the diagnosis; hence, BLC was done which revealed pathologic findings suggesting PAP. BLC appears to be a promising diagnostic tool for the diagnosis of PAP and offers several diagnostic advantages compared to conventional techniques.