of Medicine A 19 year-old man with pulmonary alveolar proteinosis was admitted to our hospital. Pulmonary lavage was performed 9 times for two years because of repeated and worsening symptoms. The chest film on admission showed bilateral pulmonary infiltrates with micronodular dissemination and multicystic shadows in the left lower lung filed, but with the lapse of time the chest films revealed a slow increase in multicystic shadows of various size throughout bilateral lung fields. Then the

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... ent suffered from bilateral pneumothoraces and died of respiratory failure. At autopsy, macroscopic findings of the lungs revealed consolidation in the interior part and many cysts of venous sizes in the subpleural area. Histologically much amorphus material filled in alveoli with or without thickened alveolar walls and many cysts might be considered emphysematous bulla or bronchioloectasis due to lung fibrosis.