Pulmonary alveolar microlithiasis with minimal symptoms and near-complete whiteout on chest imaging

Area of Science:

• Pulmonary Medicine
• Rare Diseases
• Medical Imaging

Background:

• Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic interstitial lung disease.
• Characterized by the accumulation of calcium and phosphate crystals within the pulmonary alveoli.
• Diagnosis can be challenging due to its rarity and varied presentation.

Observation:

• A 66-year-old female presented with incidentally discovered diffuse pulmonary calcifications.
• Clinical-radiological dissociation and characteristic chest computed tomography (CT) findings suggested PAM.
• Diagnosis was confirmed by typical imaging, transbronchial lung biopsy, and a positive family history.

Findings:

• Transbronchial lung biopsy is critical for definitive diagnosis of PAM, excluding other conditions.
• The case underscores the importance of integrating imaging, biopsy, and family history for accurate PAM diagnosis.
• Hallmark imaging features on chest CT aid in early suspicion of this rare lung disease.

Implications:

• Definitive diagnosis of PAM relies on a combination of clinical, radiological, and pathological findings.
• Symptomatic management of PAM presents a significant challenge due to the lack of established treatment guidelines beyond lung transplantation.
• Further research into the genetic basis and therapeutic strategies for PAM is warranted.