Chest imaging: pulmonary alveolar proteinosis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest imaging: pulmonary alveolar proteinosis

Sample item

A 35-year-old man with progressive breathlessness has a milky fluid on bronchoalveolar lavage. Which HRCT pattern is most characteristic of his condition?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ground-glass opacity with smooth interlobular septal thickening in a sharply demarcated geographic distribution (crazy paving)

Pulmonary alveolar proteinosis fills the alveoli with lipoproteinaceous material and gives crazy paving with sharp geographic borders. Whole lung lavage is the main treatment in symptomatic cases. Honeycombing indicates fibrosis, and tree-in-bud indicates small airway infection.

Option by option

  • A. Tree-in-bud nodules with bronchiectasis

    Tree-in-bud suggests endobronchial infection.

  • B. Ground-glass opacity with smooth interlobular septal thickening in a sharply demarcated geographic distribution (crazy paving) (correct)

    Correct. Geographic crazy paving with milky lavage fluid indicates alveolar proteinosis.

  • C. Upper-zone thin-walled cysts with preserved lung volume

    Upper-zone cysts suggest Langerhans cell histiocytosis.

  • D. Bilateral basal subpleural honeycombing

    Honeycombing is the pattern of established fibrosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Ground-glass opacity with smooth interlobular septal thickening in a sharply demarcated geographic distribution (crazy paving). Pulmonary alveolar proteinosis fills the alveoli with lipoproteinaceous material and gives crazy paving with sharp geographic borders.

Why is "Tree-in-bud nodules with bronchiectasis" not the answer?

Tree-in-bud suggests endobronchial infection.

Why is "Upper-zone thin-walled cysts with preserved lung volume" not the answer?

Upper-zone cysts suggest Langerhans cell histiocytosis.

Why is "Bilateral basal subpleural honeycombing" not the answer?

Honeycombing is the pattern of established fibrosis.

What concept does this question test?

It tests Chest imaging: pulmonary alveolar proteinosis in Radiology. Whole lung lavage is the main treatment in symptomatic cases. Honeycombing indicates fibrosis, and tree-in-bud indicates small airway infection.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest imaging: pulmonary alveolar proteinosis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.