A Case of Pulmonary Alveolar Proteinosis associated with Pulmonary Silicosis

A 53 years old man complaining productive cough and dyspnea admitted to a hospital on 8th March, 1982. Chest X-ray showed the fine granular shadow through out lung fields. Arterial blood gas tensions were PO2 31 torr, PCO2 27 torr and AaDO2 86 torr at pH 7.45. Transbronchial lung biopsy was performed and the microscopic findings of which showed eosinophilic, PAS positive granular materials filled in the intraalveolar space and the swelling of the alveolar lining cells. The patient was diagnosed as pulmonary alveolar proteinosis and was saved by bronchoalveolar lavage with the aid of extracorporeal circulation. Histochemical and electron microscopic observation and biochemical analysis were performed, and it was suggested that the materials accumulated in the intraalveolar space were mostly originated from the lung surfactant secreted by the pulmonary alveolar cells type II