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 Table of Contents  
CHEST IMAGE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 51-52

Pulmonary alveolar microlithiasis


1 Department of Pulmonary Medicine, All Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Pediatric Surgery, RML Hospital, New Delhi, India

Date of Submission25-Jun-2020
Date of Decision30-Jul-2020
Date of Acceptance05-Aug-2020
Date of Web Publication15-Feb-2021

Correspondence Address:
Dr. Sudheer Tale
Department of Pulmonary Medicine, AIIMS, Rishikesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacp.jacp_30_20

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  Abstract 


Pulmonary alveolar microlithiasis is a rare genetic disorder and the affected people often presented with shortness of breath on exertion and dry cough. Chest radiology shows diffuse micronodules with calcifications that are easily visible on noncontrast computed tomography scans. It is progressive disease and treatment is only supportive.

Keywords: Alveolar mircolithiasis, calcification, genetics


How to cite this article:
Tale S, Prakash V, Gangakhedkar M, Kolli M, Garbhapu AK, Sindhwani G. Pulmonary alveolar microlithiasis. J Assoc Chest Physicians 2021;9:51-2

How to cite this URL:
Tale S, Prakash V, Gangakhedkar M, Kolli M, Garbhapu AK, Sindhwani G. Pulmonary alveolar microlithiasis. J Assoc Chest Physicians [serial online] 2021 [cited 2021 Jun 13];9:51-2. Available from: https://www.jacpjournal.org/text.asp?2021/9/1/51/309471



A 24-year-old male patient presented to the outpatient department with progressively increasing dyspnea and nonproductive cough for the preceding 1 year. He was a nonsmoker and had no addictions. He had previously received a full course of antitubercular drugs that had been advised based solely on chest radiograph findings, with no significant improvement in symptoms. His examination was significant for digital clubbing, tachypnea, and fine basal crepitations. High-resolution computed tomography (HRCT) of the chest showed widespread micronodules throughout the bilateral lung fields with ground glass opacities and septal thickening [Figure 1]. Mediastinal window sections of the HRCT revealed diffuse nodular calcifications along the interlobar septa and in subpleural regions [Figure 2]. In cytospin smears of bronchoalveolar lavage, round to oval microliths were seen, suggesting the diagnosis of pulmonary alveolar microlithiasis (PAM).
Figure 1 HRCT image of chest showing diffuse micronodules, groundglass opacities and septal thickening

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Figure 2 Mediastinal window of the chest showing subpleural calcifications, nodules and septal thickening

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  Discussion Top


PAM is a rare genetic disorder with an autosomal recessive pattern of transmission characterized by deposition of calcium phosphate crystals within the alveoli known as microliths due to mutations in the solute family carrier gene SLC34A2, causing loss of function in the sodium phosphate cotransporter type IIb.[1] This results in intra-alveolar accumulation of phosphate, creating a nidus for microlith formation. There are very few cases in the literature with reported prevalence of 500 cases worldwide. Typical radiological findings are diffuse micronodules in bilateral lung fields, ground glass opacities, and subpleural calcification as seen in our case.[2] Diagnosis is made by bronchoalveolar lavage or lung biopsy, which demonstrates microliths within the alveoli.[3] There is no definitive treatment for this condition except for lung transplantation and the posttransplant recurrence of this condition is not reported in the literature.[4]

Financial support and sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Saito A, McCormack FX. Pulmonary alveolar microlithiasis. Clin Chest Med 2016;37:441-8.  Back to cited text no. 1
    
2.
Deniz O, Ors F, Tozkoparan E, Ozcan A, Gumus S, Bozlar U et al. High resolution computed tomographic features of pulmonary alveolar microlithiasis. Eur J Radiol 2005;55:452-60.  Back to cited text no. 2
    
3.
Monabati A, Ghayumi MA, Kumar PV. Familial pulmonary alveolar microlithiasis diagnosed by bronchoalveolar lavage. A case report. Acta Cytol 2007;51:80-2.  Back to cited text no. 3
    
4.
Samano MN, Waisberg DR, Canzian M, Campos SV, Pêgo-Fernandes PM, Jatene FB. Lung transplantation for pulmonary alveolar microlithiasis: a case report. Clinics 2010;65:233-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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