Imaging

Alveolar Proteinosis

Preliminary Diagnosis: Alveolar Proteinosis

I. What imaging technique is first-line for this diagnosis?

Plain radiography of the chest, PA and lateral views

II. Describe the advantages and disadvantages of this technique for diagnosis of alveolar proteinosis.

Advantages

  • Highly portable, fast imaging modality

  • Exposes the patient to negligible ionizing radiation

  • Relatively inexpensive imaging modality

Disadvantages

  • Low sensitivity and specificity for diagnosing a primary parenchymal or pleural process and identifying any secondary complications

  • Less specific in characterizing a focal consolidation compared with companion CT/high-resolution CT examination

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • CT of the chest with IV contrast

  • High-resolution CT of the chest (noncontrast)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of alveolar proteinosis.

CT of the chest with IV contrast

Advantages

  • Highly specific in characterizing an alveolar airspace process

  • Highly sensitive and specific in detecting a primary pulmonary process and identifying and characterizing any secondary complications

  • CT scanning may better guide treatment planning than plain radiography.

Disadvantages

  • Exposes patients to larger amounts of ionizing radiation compared with plain radiography

  • Less portable than plain radiography

High-resolution CT of the chest (noncontrast)

Advantages

  • More exquisite in detailing underlying parenchymal and pleural architecture and better evaluates the secondary pulmonary lobule

Disadvantages

  • Exposes patients to larger amounts of ionizing radiation compared with plain radiography

  • Less portable than plain radiography

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest with IV contrast

  • CT scanning may be contraindicated in pregnant patients.

High-resolution CT of the chest (noncontrast)

  • CT scanning may be contraindicated in pregnant patients.

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