Bilateral Upper Zone Patchy Opacities on the Chest Radiography Taken for Screening in a Patient without Any Smptoms: What Is Your Diagnosis?

Pulmonary alveolar proteinosis (PAP), is a rare diffuse lung disease characterized by the accumulation of amorphous, periodic acid-Schiff (PAS) lipoproteinaceous material (surfactant phospholipids and proteins) in the distal terminal airways and alveoli. Dyspnea, cough and sputum production are the most common symptoms in patients. High resolution computed tomography (HRCT) reveals the characteristic geographic pattern consisting of ground-glass opacities superimposed with smoothly thickened reticular (septal) lines. Bronchoalveolar lavage (BAL) and/or transbronchial biopsy with bronchoscopy is performed for the diagnosis. Opaque or milky appearance of BAL is typical and alveolar macrophages containing PAS-positive material and acellular amorphous eosinophilic PAS-positive material is observed with cytological examination of BAL. We presented a case without any sypmtoms who was diagnosed as PAP with diagnostic examinations because of both upper lung zone patchy densities on chest X-ray taken for screening.