A 72-year-old woman was brought to the hospital emergency department with a history of 8 hours of abdominal pain and vomiting. The clinical examination was unremarkable. A plain x-ray of the abdomen showed multiple air/fluid levels. She was admitted to the surgical ward with a suspected mesenteric vascular ischemia. Her condition in the next 24 hours waxed and waned, with stable vital signs. On a repeat film, her earlier x-ray findings were not seen. She had a history of hypertension and was on irregular treatment. She had had similar episodes of abdominal pain with vomiting during the 10 days prior to this presentation. They were of short duration and self-limiting.On the second day, she developed sudden hypotension and dyspnea. The abdominal pain worsened. An ECG revealed an acute ST-elevation inferior myocardial infarction (AMI). (The ECG at admission had been within normal limits.) While she was being managed for the AMI, a repeat x-ray and an abdominal ultrasound confirmed the presence of mesenteric vascular ischemia. She was stabilized with conservative management.A high-risk consent was obtained and she underwent a successful bowel resection. The surgical findings were of a gangrenous small bowel, sparing 70 to 90 cm of the jejunum after the duodenojejunal flexure, and a gangrenous colon extending up to the proximal third of the transverse colon. The pathology report of the resected bowel identified intestinal infarction due to mesenteric vascular occlusion.An echocardiogram was done postoperatively. To our surprise, it revealed a large, highly mobile mass in the left atrium. It moved freely in and out of the mitral valve orifice with each cardiac cycle. It was attached to the interatrial septum. The distal border was shaggy in appearance and showed small multiple hyperechoic areas. The clinical diagnosis of the mass was a left atrial myxoma. The clinical picture was now explainable as resulting from emboli thrown from the myxoma migrating into the mesenteric and coronary vasculature.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease, usually accidentally detected in asymptomatic patients on routine chest radiography and confirmed by lung biopsy. We report on 4 cases with various presentations and give a brief review of the literature. These cases are the first of PAM to be reported from Kuwait and with the possibility of two modes of inheritance.