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Published on: June 16, 2020
A case of pulmonary alveolar microlithiasis with Cor Pulmonale
1Department of Radiology, Beijing Hospital, the Fifth Clinical Medicine College of Peking University, Beijing, China.
Abstract:
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the formation and deposition of microliths within the alveoli and a paucity of symptoms in contrast to the imaging findings. It has familial tendency and is thought to be an autosomal recessive disorder with the mutation in the SLC34A2 gene. We describe a case of PAM with Cor Pulmonale. Ultrasonic cardiogram showed pulmonary hypertension (82 mmHg). Chest radiography revealed diffuse, bilateral sandstorm-like micronodules with greater density in the lower lung fields. HRCT scans demonstrated diffuse ground-grass opacities, thickening and calcification of interlobular septa and confluent calcified nodules. A diagnosis of PAM was suggested and confirmed by transbronchial lung biopsy (TBLB).
Insights
Pulmonary alveolar microlithiasis (PAM), a rare lung disease, involves microlith deposits. This case highlights its association with Cor Pulmonale and diagnostic imaging findings.
Area of Science:
- Pulmonology
- Rare Diseases
- Genetics
Background:
- Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disorder.
- Mutations in the SLC34A2 gene are associated with PAM.
- PAM is characterized by microlith deposition in lung alveoli, often with subtle symptoms.
Observation:
- A case of PAM presenting with Cor Pulmonale is described.
- Echocardiography revealed pulmonary hypertension (82 mmHg).
- Chest radiography showed diffuse, bilateral sandstorm-like micronodules, predominantly in lower lung fields.
Findings:
- High-resolution CT (HRCT) scans demonstrated ground-grass opacities, thickened/calcified interlobular septa, and confluent calcified nodules.
- Diagnosis was suspected based on imaging characteristics.
- Transbronchial lung biopsy (TBLB) confirmed the presence of microliths, establishing the PAM diagnosis.
Implications:
- This case underscores the importance of characteristic imaging findings in diagnosing PAM.
- Understanding PAM's presentation aids in early detection and management of associated conditions like Cor Pulmonale.
- Further research into SLC34A2 gene mutations can improve diagnostic accuracy and therapeutic strategies for PAM.
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