Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?

Abstract

ObjectiveThe present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma.Materials and MethodsThirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed.ResultsGround-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%).ConclusionAs regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.

Pulmonary Alveolar Microlithiasis

“…In a radiological study of 13 PAM cases in Brazil, CT findings in decreasing order of prevalence included ground glass opacities, small parenchymal nodules, and small subpleural nodules in over 90%; subpleural cysts in 85%; and subpleural linear calcifications, crazy paving pattern, nodular fissure, calcification along interlobular septa, and dense consolidations in 46–70% 43 . Intermingled air bronchograms were identified in 6 cases.…”

Pulmonary Alveolar Microlithiasis:AIRP Best Cases in Radiologic-Pathologic Correlation

“…At presentation, many patients are asymptomatic, with PAM being identified only when important characteristic findings are seen on radiographs obtained for preoperative, employment, or familial disease screening (2). Affected individuals generally do not become symptomatic until the 3rd or 4th decade of life, with dyspnea being the most common symptom (8). Other symptoms include cough, sputum production, malaise, chest pain, and hemoptysis.…”

“…Although many findings can be observed on chest radiographs, high-resolution CT is the preferred imaging modality for evaluating possible findings of PAM owing to its increased sensitivity in depicting subtle parenchymal changes (9). The most common findings are diffuse ground-glass opacity and small calcified parenchymal nodules, which preferentially involve the posterior, inferior, and central regions of the lungs (8,9,12). Other CT features include calcifications along the interlobular septa, bronchovascular bundles, fissures, and pleura; subpleural nodules and cysts; and dense areas of consolidation (8).…”

Utility of the inspiratory phase in high-resolution computed tomography evaluations of pediatric patients with bronchiolitis obliterans after allogeneic bone marrow transplant: reducing patient radiation exposure

“…Although CT of the chest has been the subject of a series of recent publications in the Brazilian radiology literature of Brazil (30-38) , there have been, to our knowledge, no studies with a similar aim.…”