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Chest Imaging

Alveolar proteinosis

disease characterized by filling of alveolar spaces by proteinaceous material, rich in lipid, and related to surfactant. The majority of cases are idiopathic, but some cases result from exposure to dusts (particularly silica) or from immunological disturbances (immunodeficiency, haematologic and lymphatic malignancy, chemotherapy). Symptoms are usually mild and insidious. Treatment consists of bronchoalveolar lavage. Radiographic findings are bilateral, patchy, diffuse, or perihilar air-space consolidation or ground-glass opacity, often most severe at the lung bases. High resolution CT (HRCT) findings are confluent ground glass opacity or air-space consolidation. ground glass opacity or consolidation is sharply demarcated from surrounding normal lung. A combination of geographic ground glass opacity and interlobular septal thickening in the same regions is typical of alveolar proteinosis (Fig.1); this finding is termed "crazy-paving" (see crazy paving pattern).

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Fig.1

High resolution CT scan in a patient with alveolitis proteinosis showing a crazy paving pattern: geographic distribution of areas of ground-glass attenuation containing thickened interlobular septa.
Alveolar proteinosis, Fig.1