Composition of Lung Lavage in Pulmonary Alveolar Microlithiasis

Abstract

A case of pulmonary alveolar microlithiasis (PAM) is reported wherein total lung lavage was performed for relief of dyspnea. Characterization of the lavage material and examination of the microliths isolated from the lavage fluid confirmed previous reports of their spherical-ovoid shape and a 2:1 calcium to phosphate composition. The microliths contained considerable amounts of ionizable iron and generated oxidants in an in vitro system. A detailed biochemical analysis of the lavage fluid reflected elevations in total protein, phosphatidylserine, phosphatidylglycerol and the ratio of phosphatidylglycerol to phosphatidylinositol. Surfactant apoprotein-A levels approximated that of normal patients. The potential roles of oxidant generation and alterations in surfactant metabolism are discussed in the context of the pathogenesis of PAM.

Increased expression of apoptosis signalling receptors by alveolar macrophages in sarcoidosis

“…Surfactant abnormalities have been reported for some other rare, lung diseases, such as eosinophilic granuloma [40] and pulmonary alveolar microlithiasis (table 4) [84]. Unfortunately, lavages are often performed in these rare diseases but are seldom analysed with respect to pulmonary surfactant.…”

Pulmonary alveolar microlithiasis: two case reports and review of the literature

“…Observational studies have found therapeutic BAL to be ineffective [62][63][64], except for symptomatic improvement in one case, without improvement in conventional pulmonary radiography and HRCT [36].…”

“…Typical findings within the alveolar spaces are numerous calcified bodies, concentrically laminated with an onion skin-like appearance. The microliths usually range from 50 to 1,000 mm in diameter [22,25,[35][36][37][38][39], although microliths up to 5,000 mm in size have been reported [40]. The microliths are mainly composed of calcium and phosphorus and, to a lesser degree, of varying amounts of iron, magnesium, potassium and copper.…”

“…The microliths are mainly composed of calcium and phosphorus and, to a lesser degree, of varying amounts of iron, magnesium, potassium and copper. Variable degrees of fibrosis are shown in the lung interstitium [22,25,[36][37][38]40].…”

“…In one case, treatment with prednisolone (20 mg daily) for 6 months showed improvement on wheezing and chest tightness, but symptoms recurred when the treatment was discontinued. The patient had normal lung function and the authors discussed the possibility that the patient was suffering from asthma in addition to PAM, and that the symptoms might be caused by an inflammatory reaction due to the microliths or to some other respiratory irritant [36].…”