A 72-year-old male presented due to a clinical picture of dyspnea with subacute onset and hypoxemia. He was a smoker with no significant clinical history. The chest X-ray showed a diffuse pattern in the right lung and computed tomography of the chest revealed a crazy paving pattern in the right lung and ground-glass opacities in the left lower lobe. Flexible bronchoscopy under conscious sedation was performed. No gross endobronchial signs were observed. Bronchoalveolar lavage (BAL) was performed and transbronchial biopsies were obtained from the right upper lobe. When the BAL fluid was aspirated, it was observed to contain whitish particles, with a snowstorm appearance (see video [appendix]). To our knowledge, this phenomenon in BAL fluid has not been previously described.1,2 Cytological analysis of the BAL sample showed groups of tumor cells with moderately atypical nuclei. The transbronchial biopsy showed alveolar spaces lined with adenocarcinoma cells in a predominantly lepidic pattern. In general, BAL fluid obtained on endoscopy appears as a transparent fluid without the suspended particles that were observed in this case. The “snowstorm” appearance may have been caused by the massive amount of tumor cells found in the BAL fluid.
Please cite this article as: Curull V, Chalela R, Sánchez-Font A. Tormenta de nieve en el lavado broncoalveolar. 2013. Arch Bronconeumol. 2014;50:305.
