Whole Lung Lavage in a Patient with Pulmonary Alveolar Proteinosis: A Case Report

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of protein and lipid material, called surfactant, within the air sacs or alveoli of the lungs with for unknown reasons. Because of the unknown pathogenesis, the most effective treatment for PAP is the mechanical removal of the proteinaceous material via whole-lung lavage (WLL) with isotonic saline as the lavage solution, and mechanical chest percussion during lavage. Serial arterial blood-gas determinations and measurement of lung compliance are done in during the intraoperative and postlavage periods. The major complications of WLL are hypoxia, circulatory disturbance and difficulty in positioning the double lumen endotracheal tube. An experienced team is needed in the operating room and a postoperative care facility is also required to reduce complications. Here we report a 44-year-old man with a history of diesel fuel inhalation, suffered from dyspnea on exertion, a productive cough, and low-grade fever. An open lung biopsy confirmed the diagnosis of PAP. The patient underwent WLL under general anesthesia. His clinical symptoms were improved and discharged with a relatively stable condition.