Welcome to the first #PulmPEEPs radiology rounds of 2022!
You are concerned for diffuse alveolar infiltrates on chest x-ray and you obtain a CT chest for better parenchymal visualization. How would you best describe the imaging findings on CT chest?
The CT chest shows bilateral areas of ground-glass opacities with both intralobular and interlobular septal thickening.
The patient undergoes a bronchoscopy with a BAL. The BAL fluid is milky and the period-acid Schiff (PAS) stain returns positive. What is the most likely diagnosis?
The BAL fluid can appear milky and the PAS stain is positive in PAP from the build-up of surfactant proteins filling the alveolar spaces. The majority of PAP cases are due to antibodies against GM-CSF. Treatment is typically whole lung lavage and GM-CSF is becoming more common.
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