Pulmonary alveolar proteinosis is often treated with bronchopulmonary lavage. Transoesophageal echocardiography has been used to detect lung atelectasis in critical situations. A 68-yr-old male with pulmonar alveolar proteinosis underwent bronchopulmonary lavage and was examined using transoesophageal echocardiography. His dependent left-lung area was observed through the descending aorta. Following saline infusion, no bright areas containing air were observed. The average area of the air-free region following instillation was 37.4 ± 1.8 cm2, which decreased to 22.8 ± 2.6 cm2 after drainage (P < 0.001). There was a significant relationship between the percentage venous admixture and air-free area during lavage (P < 0.05, r = −0.76). The image of the right lung was unclear. Transoesophageal echocardiography can yield useful information about the lung during bronchopulmonary lavage.