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首页> 外文期刊>Journal of Medical Case Reports >Therapeutic limited bronchoalveolar lavage with fiberoptic bronchoscopy as a bridging procedure prior to total lung lavage in a patient with pulmonary alveolar proteinosis: a case report
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Therapeutic limited bronchoalveolar lavage with fiberoptic bronchoscopy as a bridging procedure prior to total lung lavage in a patient with pulmonary alveolar proteinosis: a case report

机译：肺泡蛋白沉着症患者行全肺灌洗前行纤维支气管镜治疗性支气管肺泡灌洗：一例

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Introduction Therapeutic total lung lavage under general anesthesia is the current mainstay of treatment for pulmonary alveolar proteinosis, which is a rare lung disease characterized by alveolar accumulation of surfactant. Therapeutic limited bronchoalveolar lavage is considered an alternative treatment to conventional total lung lavage. Case presentation A 61-year-old, previously healthy, Sri Lankan Moor woman presented to our facility with progressively worsening difficulty in breathing and persistent dry cough for one year. Her respiratory examination revealed bibasal fine end-inspiratory crepitations. A chest radiograph showed bilateral mid and lower zone alveolar interstitial shadows and a high-resolution computed tomography scan of her chest revealed septal thickening with ground-glass shadows more on mid and lower zones bilaterally. A diagnostic bronchoalveolar lavage fluid analysis revealed diastase-resistant protein clumps in periodic acid Schiff stain. The diagnosis was made as pulmonary alveolar proteinosis. An arterial blood gas analysis performed prior to intervention revealed a significant hypoxia (partial pressure of oxygen - 64mmHg) with alveolar-arterial gradient was 35.4mmHg. Therapeutic limited bronchoalveolar lavage was arranged and her right and her left lung were lavaged separately in two sessions done two weeks apart under local anesthesia. Our patient had significant clinical improvement and resolution of the bilateral septal thickening with minimal resolution of the ground-glass opacities in a repeat high-resolution computed tomography scan done two weeks later. Subsequently, a total lung lavage under general anesthesia was also done, which improved her dyspnea and arterial hypoxemia. Conclusions Therapeutic limited bronchoalveolar lavage can be successfully performed as an interval bridging procedure, as a ‘prewash’, prior to conventional total lung lavage for pulmonary alveolar proteinosis.
机译：引言全身麻醉下治疗性全肺灌洗是目前治疗肺泡蛋白沉着症的主要手段，这是一种罕见的以表面活性剂肺泡积聚为特征的肺部疾病。治疗性支气管肺泡灌洗被认为是常规全肺灌洗的替代治疗。案例介绍一名61岁，以前健康的斯里兰卡摩尔人女性到我们医院就诊，呼吸困难逐步加重，持续干咳一年。她的呼吸系统检查发现双基础细末吸气结。胸部X光片显示双侧中下部区域的肺泡间隙阴影，并且对胸部进行的高分辨率计算机断层扫描显示双侧中部和下部区域的间隔增厚并伴有玻璃阴影。诊断性支气管肺泡灌洗液分析显示高碘酸希夫（Schiff）染色中抗消化酶的蛋白质团块。诊断为肺泡蛋白沉着症。干预前进行的动脉血气分析显示明显的缺氧（氧分压-64mmHg），肺泡-动脉梯度为35.4mmHg。在局部麻醉下，在相隔两周的两个疗程中安排了有限的治疗性支气管肺泡灌洗，分别对她的右肺和左肺进行了灌洗。我们的患者在两周后再次进行了高分辨率计算机断层扫描，临床上得到了明显的改善，双侧中隔增厚得到了解决，而磨玻璃片混浊的分辨率却最小。随后，在全身麻醉下进行了全肺灌洗，改善了她的呼吸困难和动脉血氧不足。结论在常规的全肺灌洗治疗肺泡蛋白沉着病之前，可以有限的治疗性支气管肺泡灌洗作为“预洗”作为间隔桥接程序成功进行。

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