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. 2024 Nov 18;12(11):e9588.
doi: 10.1002/ccr3.9588. eCollection 2024 Nov.

Whole Lung Lavage in Autoimmune Pulmonary Alveolar Proteinosis: Unique Challenges in a Resource-Limited Setting

Ashesh Dhungana  1 , Buddhi Sagar Lamichhane  1 , Prajowl Shrestha  1 , Deepa Kumari Shrestha  1 , Ritamvara Oli  1 , Shreya Dhungana  1 , Pratibha Bista  2
Affiliations

Whole Lung Lavage in Autoimmune Pulmonary Alveolar Proteinosis: Unique Challenges in a Resource-Limited Setting

Ashesh Dhungana et al. Clin Case Rep. .

Abstract

Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource-limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y-type bladder irrigation catheter for saline instillation and drainage.

Keywords: autoimmune PAP; bronchoalveolar lavage; pulmonary alveolar proteinosis; whole lung lavage.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) Shows chest X‐ray taken at the time of presentation and (B) after three sessions of whole lung lavage.
FIGURE 2
FIGURE 2
HRCT chest showing diffuse ground glass opacities and consolidation with superimposed smooth interstitial thickening giving “crazy paving” pattern at presentation (A), significant clearing of GGO's and interlobular septal thickening after three sessions of WLL (B).
FIGURE 3
FIGURE 3
BAL fluid cytology showing periodic acid–Schiff (PAS) stain‐positive amorphous, eosinophilic material along with few scattered macrophages.
FIGURE 4
FIGURE 4
Y type TUR bladder irrigation catheter. The labels show catheter attachments during WLL procedure.
FIGURE 5
FIGURE 5
Serial lavage samples showing milky effluent fluid with sedimentation obtained during WLL. First session (A), second session (B), and third session (C). Serial aliquots show progressive clearing.
See this image and copyright information in PMC

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