Diffuse hyperdense micronodular airspace opacities in pulmonary alveolar microlithiasis

A 44-year-old woman with a childhood history of pulmonary tuberculosis presented with mild exertional dyspnoea and abnormal chest radiographic imaging (figure 1) obtained at an external facility, which showed diffuse, fine calcific micronodules throughout the lung parenchyma. She was informed of an incidental finding of ‘lung disease’ 15 years prior after a motor vehicle accident, for which she was unable to obtain follow-up. She had no other symptoms; physical examination and laboratory results were unremarkable. Chest CT imaging (figure 2) demonstrated diffuse hyperdense micronodular airspace opacities indicative of pulmonary alveolar microlithiasis (PAM). Pulmonary function testing showed restrictive ventilatory defects with a diffusing capacity for carbon monoxide of 28%. Testing for tuberculosis was negative. Transbronchial biopsies performed at an external facility revealed intra-alveolar lamellar spherules, confirming PAM. Over 4 years, the patient experienced worsening exertional dyspnoea, requiring oxygen therapy, leading to bilateral lung transplantation, after which she...
Source: Thorax - Category: Respiratory Medicine Authors: Tags: Images in Thorax, Thorax Source Type: research