Pulmonary alveolar microlithiasis (PAM) is an uncommon chronic disease characterized by calcifications within the alveoli and a paucity of symptoms in contrast to the imaging findings. We present a 59-year-old woman with a 4-year history of shortness of breath on exertion. Lung auscultation revealed random wheezes and fine and coarse crackles. Pulmonary function tests showed a restrictive pattern. The chest radiograph demonstrated a bilateral symmetric micronodular pattern. High resolution CT scan revealed diffuse ground-glass attenuation with superimposed septal thickening ("crazy-paving" pattern). The patient underwent a lung biopsy, which confirmed the diagnosis of PAM. Our case demonstrates that PAM needs to be considerate in the differential diagnosis of lung lesions that present with crazy-paving pattern on the high resolution CT.

ABSTR AC T Background and study aims Difficult biliary cannulation and unintentional pancreatic duct cannulation are thought to be important contributors to pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Our aim was to compare and evaluate the rates of success and complications of transpancreatic precut papillotomy (TPPP) and the double-guidewire technique (DGT), both with prophylactic pancreatic stenting.Patients and methods From April 2011 to March 2014, patients with difficult biliary cannulation, in whom we planned to first position a guidewire in the pancreatic duct, were enrolled, and 68 patients were prospectively randomly allocated to two groups (TPPP 34, DGT 34). We evaluated the rates of success and complications for each group.Results TPPP had a significantly higher success rate (94.1 %) than DGT (58.8 %). The rate of post-ERCP pancreatitis was 2.9 % in both groups. There was no significant difference between the two groups in the overall rate of complications related to cannulation.

Analysis of the 10-year long-term results after non-surgical management of hepatolithiasis identified liver atrophy and congenital biliary dilatation as risk factors for mortality. Patients with hepatic lobe atrophy should undergo a hepatectomy, if operable.

Old age was associated with a similar complication rate to younger age but increased the severity of complications following endoscopic biliary stone removal. Improved awareness of the severity of complications may be of benefit during periprocedural management. Further studies are warranted.

It is suggested that treatment by EPLBD for large bile duct stones may be safe and useful.