PMC3395170_01
PA radiograph on admission: well-inflated lungs with diffuse bilateral coarse reticular opacities and left IJ port.
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fig1
Chest radiograph showed diffuse ground glass alveolar infiltrates which were chronic in nature when compared to a chest X-ray from one year prior (Figure 1).
Evidence of pulmonary alveolar proteinosis: papanicolaou stain of bronchoalveolar lavage (BAL) fluid at medium power (20x) view showing large, amorphous, acellular aggregates with a pulmonary macrophage adjacent to an aggregate in a background of chronic inflammatory cells (a). Periodic acid-Schiff (PAS) histochemical stain of BAL fluid at high power (40x) highlights both the large extracellular amorphous aggregates as well as material within pulmonary macrophages (b).
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fig2
Light microscopic examination of BAL fluid using Periodic acid-Schiff (PAS) stain was positive for abundant amorphous material within the pulmonary macrophages and also in larger extracellular aggregates suggesting pulmonary alveolar proteinosis (Figure 2).