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A Biopsy demonstrating dilated air spaces, thickened interlobular septae and relatively acellular, eosinophilic debris within the alveoli. Hematoxylin and eosin stain, original magnification ×100. B Higher power inspection of the alveoli demonstrating thick, amorphous material with scattered pulmonary macrophages. Hematoxylin and eosin stain, original magnification ×400. Note: Grocott’s methanamine silver staining was negative and ruled out pneumocystis pneumonia in the differential of ‘crazy-paving’ | Patel, S. M., Sekiguchi, H., Reynolds, J. P., & Krowka, M. J. (2012). Pulmonary alveolar proteinosis. Canadian respiratory journal, 19(4), 243–245. https://doi.org/10.1155/2012/841530

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