case_images: PMC11814212_01
case_images: The preoperative lung CT scan of the patient showed a characteristic sign of pulmonary alveolar proteinosis, termed as "crazy paving pattern", also known as "paving stone sign".
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case_images: PMC11814212_01_fped-13-1496553-g001.jpg
case_images: F1
case_images: Chest CT indicated a diffuse increase in lung density, with a "crazy paving" pattern (Figure 1).
case_images: (A) Placing the BB outside the endotracheal tube and fixing the position. (B) Under direct vision using a fiberoptic bronchoscope, the balloon of the BB is positioned at the left bronchial opening, as indicated by the black arrow. (C) The bronchial blocker. The number 1 is the inflation port of the BB, which is connected to the balloon at the end; the number 2 is the suction port of the BB; the number 3 is the balloon and the caudal end of the BB.
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case_images: PMC11814212_01_fped-13-1496553-g002.jpg
case_images: F2
case_images: Co., Ltd., China) transglottically into the trachea, followed by rapid insertion of a 4.5-sized uncuffed endotracheal tube (internal diameter 4.5 mm, external diameter 6.5 mm) to a depth of 12 cm (Figure 2A). Confirmation of the tube's tip position was achieved by auscultation of bilateral breath sounds. After stabilizing the patient's oxygen saturation, we utilized a fiberoptic bronchoscope to adjust the BB cuff position through the three-way stopcock of the respiratory circuit, positioning it precisely at the left main bronchus ostium (Figure 2B).
case_images: (A) A nurse used a high-frequency chest wall oscillation machine to vibrate the patient's left lung area. (B) A syringe connected to the suction port was used to aspirate the lavage fluid, as indicated by the black arrow.
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case_images: F3
case_images: This process of irrigation, vibration, and repositioning was repeated multiple times (Figure 3).
case_images: The lavage fluid, it gradually become clear from right to left.
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case_images: PMC11814212_01_fped-13-1496553-g004.jpg
case_images: F4
case_images: Lavage continued until the fluid returned clear (Figure 4).