Chest
CLINICAL INVESTIGATIONSLobar Lavage: Therapeutic Benefit in Pulmonary Alveolar Filling Disorders
Section snippets
Pulmonary Alveolar Proteinosis
This 45-year-old Caucasian man developed a progressive course of shortness of breath, nonproductive cough, fever and night sweats in November, 1970. In February, 1971, the patient underwent an open lung biopsy, which revealed the classic pathologic picture of pulmonary alveolar proteinosis. He related a 30-pack-year history of cigarette smoking. He had a varied occupational history. Most significant of the patient's occupations was that of sand blasting for two years, from 1965 to 1967. He had
Desquamative Interstitial Pneumonia
A 43-year-old Caucasian man was admitted to our hospital for bronchopulmonary lavage. The patient stated that the onset of shortness of breath was in 1953, and that he had worked as a sand blaster and laborer for 16 years prior. He had an extremely heavy smoking history of up to four packages of cigarettes per day for approximately 30 years. His dyspnea on exertion progressed gradually from 1953 to 1955 when he had an open lung biopsy. A diagnosis of desquamative interstitial pneumonitis was
Material and Methods
One patient with alveolar proteinosis and one patient with desquamative interstitial pneumonia underwent multiple pulmonary lavage in the manner of Finley et al.4 Briefly, the patients receive premedication with atropine and meperidine hydrochloride, then the trachea is intubated with 19 (French) cuffed bronchographic catheter under topical lidocaine (Xylocaine) or cocaine anesthesia. The catheter is placed during fluoroscopy so that lavage is performed in a different area of involvement each
Results
Lobar lavage produced significant improvement in clinical status, measured pulmonary function and x-ray film in the two patients studied. The procedure was well tolerated by both patients and no complications were experienced. Although the patients were hospitalized for this procedure, it could have been accomplished as an outpatient had it been more convenient for the patient. The patient essentially breathed the saline into his lung and little or no pressure was needed to instill the 50 ml of
Discussion
The data presented in this report confirm the usefulness of lung lavage in the treatment of PAP and demonstrate its usefulness in DIP. This alternate lavage procedure would be more useful in patients with PAP who have one or two lobes involved than the whole lung lavage procedure used by Rameriz et al.3 Our patient with PAP had extensive involvement of the lungs, illustrating that the usefulness of this technique is not limited to localized disease. Because of the simplicity and low risk of
References (6)
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Desquamative interstitial pneumonia
Am J Med
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Pulmonary alveolar proteinosis
N Engl J Med
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Bronchopulmonary lavage in man
Ann Intern Med
(1965)
Cited by (21)
Opportunistic infections in patients with pulmonary alveolar proteinosis
2012, Journal of InfectionCitation Excerpt :There was no evidence of PAP recurrence over the next 2 years. A total of 74 patients with PAP and concurrent infection with one of the pathogens of interest were identified in our comprehensive literature review.6–50 The additional case from our institution was included to arrive at a final cohort of 75 patients.
Pulmonary alveolar proteinosis: Treatment by bronchofiberscopic lobar lavage
2002, ChestCitation Excerpt :Segmental or lobar lavage has been reported as a possible alternative. Harris and colleagues16 used a cuffed bronchoscopic catheter to perform lobar lavage under fluoroscopic guidance. Brach et al17 used a modified bronchoscope with an inflated tracheostomy cuff and a Venturi mask to perform the lavage procedure.
Pulmonary Alveolar Phospholipoproteinosis: Experience With 34 Cases and a Review
1987, Mayo Clinic ProceedingsPulmonary alveolar proteinosis. Successful treatment with aerosolized trypsin
1979, The American Journal of Medicine
Manuscript received August 27; accepted January 31.