To the Editors:
Fibred confocal fluorescence microscopy (FCFM) is a new technology that can provide microscopic imaging of a living tissue through a 1-mm flexible fibreoptic miniprobe 1, 2. To image the alveolar structures in vivo, the miniprobe is advanced through the working channel of the bronchoscope down to the alveolar ducts and sacs. In nonsmoking subjects, the FCFM is able to image the peripheral elastin framework of the alveolar ducts 3. In active smokers, the technique also images fluorescent alveolar macrophages which contain tobacco tar 3. The technique has the potential to improve the in vivo diagnosis of peripheral lung diseases during bronchoscopy.
Herein we report the use of FCFM during bronchoscopy on a smoking patient presenting with diffuse alveolar and interstitial opacities on chest radiograph. The in vivo confocal fluorescence endomicroscopy in real-time showed the globular lipoproteinaceous material which is typical of pulmonary alveolar proteinosis (PAP). This diagnosis was confirmed by cytological analysis of the bronchoalveolar lavage (BAL) fluid, and by the presence of high levels of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) serum antibodies.
This is the first report of the in vivo confocal microscopic appearance of lipoproteinaceous material during bronchoscopy, which appears to be typical of PAP.
A 42-yr-old, 25 pack-yr, active smoking male presented with a 4-month history of increasing breathlessness on exertion and dry cough. He reported a history of heavy and short household plaster dust exposure preceding the onset of symptoms. The physical examination was unremarkable. The chest radiograph showed bilateral alveolar and interstitial opacities. A high-resolution computed …