Abstract
Lobar fiberoptic lung lavage is a well-known procedure used in primary pulmonary alveolar proteinosis (PAP); the use of this procedure has increased in the recent years. This procedure has also been used in other pulmonary diseases such as desquamative interstitial pneumonia with good results. We describe a case of extremely severe respiratory failure due to concurrence of PAP and Influenza A H1N1 virus pneumonia which resolved with the help of this procedure. The patient, a 41-year-old woman, needed less mechanical ventilation after undergoing lobar fiberoptic bronchoscopic lavage. Moreover, a rapid and progressive improvement in the computed tomography of the lungs was observed. Flexibile fiberoptic bronchoscopic lobar lavage is a simple, safe procedure used not only in milder disease, but also in particular severe cases in which the physiological derangement of whole lung lavage would not be tolerated by patient or when extra-corporeal membrane oxygenation is not available.
Highlights
Lobar or total lung lavage by flexibile fiberoptic bronchoscopy (FOB) is an alternative to whole lung lavage (WLL) in the treatment of pulmonary alveolar proteinosis (PAP).[1,2,3,4] Bronchopulmonary lavage was introduced by J
Paquet and Karsli utilized a twocuffed endotracheal tube for the treatment of a pediatric patient.[8]. Based on these experience we report a case of a patient with pulmonary alveolar proteinosis and presenting an influenza A H1N1 pneumonia treated and resolved with helping of FOB
The clinical presentation of PAP varies from asymptomatic (31% of acquired cases) to a more chronic presentation with dyspnoea and cough sometimes accompanied by sputum described as white and gummy or chunky.[9]
Summary
Lobar or total lung lavage by flexibile fiberoptic bronchoscopy (FOB) is an alternative to whole lung lavage (WLL) in the treatment of pulmonary alveolar proteinosis (PAP).[1,2,3,4] Bronchopulmonary lavage was introduced by J. Since there is no pediatric-size double-lumen endotracheal tube available,unilateral lung lavage by bronchofiberscope and selective ventilation, with cuffed endotracheal tube, is an alternative.[7] Paquet and Karsli utilized a twocuffed endotracheal tube for the treatment of a pediatric patient.[8] Based on these experience we report a case of a patient with pulmonary alveolar proteinosis and presenting an influenza A H1N1 pneumonia treated and resolved with helping of FOB
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