Pulmonary Alveolar Proteinosis. Diagnostic and Pathologic Implications of Pulmonary Washings

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Abstract
The frequency of diagnostic proteinaceous material in the bronchopulmonary washings from 8 patients with alveolar proteinosis and the magnitude and nature of the cellular response in serial washings of 4 patients was studied. Diagnostic material was present in 10 of 21 washings obtained by means of pulmonary segmental irrigation, and in all of the 28 washings obtained by means of whole-lung lavage. When segmental irrigation was used, a polymorphonuclear and eosino-philic response was noted. When an entire lung was lavaged and larger amounts of alveolar material were removed, an increased number of macrophages appeared in the washings and in the post-lavage sputum. The diagnosis of alveolar proteinosis can be established frequently by study of the pulmonary washings. After pulmonary irrigation, the residual alveolar material is removed, at least in part, by phagocytosis.

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