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
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Highly portable, fast imaging modality
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Exposes the patient to negligible ionizing radiation
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Relatively inexpensive imaging modality
Disadvantages
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Low sensitivity and specificity for diagnosing a primary parenchymal or pleural process and identifying any secondary complications
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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?
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No specific contraindications to plain radiography exist.
IV. What alternative imaging techniques are available?
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CT of the chest with IV contrast
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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
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Highly specific in characterizing an alveolar airspace process
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Highly sensitive and specific in detecting a primary pulmonary process and identifying and characterizing any secondary complications
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CT scanning may better guide treatment planning than plain radiography.
Disadvantages
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Exposes patients to larger amounts of ionizing radiation compared with plain radiography
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Less portable than plain radiography
High-resolution CT of the chest (noncontrast)
Advantages
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More exquisite in detailing underlying parenchymal and pleural architecture and better evaluates the secondary pulmonary lobule
Disadvantages
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Exposes patients to larger amounts of ionizing radiation compared with plain radiography
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Less portable than plain radiography
VI. What are the contraindications for the alternative imaging techniques?
CT of the chest with IV contrast
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CT scanning may be contraindicated in pregnant patients.
High-resolution CT of the chest (noncontrast)
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CT scanning may be contraindicated in pregnant patients.
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