ROLE OF INTRAOPERATIVE ULTRASOUND GUIDED CHEST PHYSIOTHERAPY DURING WHOLE LUNG LAVAGE (WLL) FOR PULMONARY ALVEOLAR PROTEINOSIS (PAP) -A CASE REPORT.

Abstract

Pulmonary Alveolar Proteinosis (PAP) is a rare disease characterized by alveolar accumulation of surfactant components in distal air spaces. ^{1, 2}

The most common symptoms are a nonproductive cough, progressive dyspnea and weight loss. The chest radiograph usually shows bilateral alveolar or nodular infiltrates without mediastinal or hilar lymphadenopathy. ² The diagnosis is made by open lung biopsy specimen or special staining of segmental bronchial washings obtained through a flexible bronchoscope. Although a number of therapeutic measures have been tried with variable results, whole lung lavage (WLL) is recognized as the most effective treatment for patients with significant dyspnea on exertion.

Although many studies have reported the importance of chest physiotherapy in pulmonary conditions especially in ICU setups, the studies on pulmonary outcome in PAP with intraoperative LUS guided chest physical therapy intervention during WLL are not available, where theoretically alveoli are flooded with lavage fluid ¹⁰. Chest physiotherapy is carried out with guided LUS which increase the effectiveness of CPT would while reducing complications and thus making the procedure safer. Hence, this case is reported   to further explore the chances of making intraoperative LUS guided chest physiotherapy during whole lung lavage in patient with pulmonary alveolar proteinosis a standard procedure.