Pulmonary alveolar microlithiasis with calcified pleural plaques

Pulmonary Alveolar Microlithiasis (PAM) is a rare disease of unknown origin. It is characterized by the presence of small calculi within the alveolar spaces, and has various clinical manifestations. Some patients may be asymptomatic for a long period of time with subsequent occurrence of dyspnea, dry cough, chest pain, and eventually, respiratory failure. Recurrent spontaneous pneumothorax episodes are a late complication of the disease. We report the case of an alveolar microlithiasis episode in a 42-year-old male, admitted to Tohid Hospital, Iran, whose first clinical presentation was symptoms of pneumothorax. He was admitted with sudden onset dyspnea and right-sided pleuretic chest pain. Following treatment of pneumothorax after chest tube placement, the pulmonary function revealed normal indices, and chest radiograph demonstrated diffuse confluence of dense micronodular infiltrate. High-resolution computerized tomography scan showed diffuse ground glass attenuation and calcifications along the interlobular septa and subpleural regions. Transbronchial lung biopsy confirmed the diagnosis of PAM.

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“…7 Our case, however, showed a normal pattern of pulmonary function studies after re-expansion of the lung.…”

Section: Discussionmentioning

confidence: 64%

“…7 In 1918, Harbitz provided an accurate autopsy of a second case but it was Puhr in 1933 who named the disease mikrolithiasis alveolaris pulmonum. 8,9 A review of 576 published cases showed that there was no gender predominance and the ages of affected patients ranged from newborn to those in their ninth decade of life .…”

Section: Discussionmentioning

confidence: 97%

First Presentation of a Case of Pulmonary Alveolar Microlithiasis with Spontaneous Pneumothorax

Sigari

Nikkhoo

2014

Oman Med J

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“…Although the radiological findings are diagnostic, many cases are mistaken for miliary tuberculosis, silicosis, berylliosis, sarcoidosis, haemosiderosis, fungal infections and carcinomatosis [8]. Radiologically, extensive micronodular opacities are seen in the basal and middle regions of both lungs in PAM.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Alveolar Microlithiasis and Preterm Delivery: A Case Report

Erdem¹,

Göktan²,

Erbay³

et al. 2014

Tur Toraks Der

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Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease characterised by extensive intra-alveolar calcium and phosphorus deposition throughout the parenchyma of both lungs. The etiology and pathogenesis of the disease is unclear. In our case, PAM with pregnancy was presented; respiratory distress had been observed during the first and second trimesters. In the following weeks, premature activity developed and the foetus was not able to stay alive. This is the third case of PAM in pregnancy described in the literature. A 36 year-old female was referred to our emergency department complaining that she had suffered from dyspnoea on a couple of occasions since the first trimestry of her last pregnancy. On suspecting a pulmonary embolism, dynamic thorax multidetector computed tomography (MDCT) was performed after the delivery. MDCT revealed typical PAM findings. In PAM, radiological signs are not compatible with clinical symptoms; thus, the clinical symptoms are not as dramatic as imaging findings. However, it should be taken into consideration that this disease, with no effective treatment, may rarely progress into end stage pulmonary disease due to conditions which alter pulmonary functions, such as pregnancy.

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“…Apical bullae can also be detected by chest X-ray or CT scans. Multiple calcified pleural plaques [49] and extensive interstitial fibrosis with traction bronchiectasis are observed rarely in our series [45].…”

Section: Investigationsmentioning

confidence: 98%

Pulmonary alveolar microlithiasis: an interesting case report with systematic review of Indian literature

et al. 2015

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Pulmonary alveolar microlithiasis is a rare disease characterized by intra-alveolar presence of microliths. This study reports an interesting case of pulmonary alveolar microlithiasis and provides a systematic review of cases reported from India. A 23-year-old female presented with a history of cough, wheeze, chest pain, and episodic wheeze for five months. Pulmonary function tests demonstrated an obstructive pattern, and chest Xray showed fine micronodular opacities predominantly involving the middle and lower zones of both lungs. Transbronchial lung biopsy revealed the diagnosis. She responded well to inhaled steroid therapy. A systematic review of literature was performed and identified 73 cases of pulmonary alveolar microlithiasis reported from India. The mean (SD) age of the patients was 28.8 (14.9) years, with an almost equal male:female ratio. Many patients were asymptomatic at presentation. Breathlessness and cough were the most common symptoms, and the disease progressed into respiratory failure associated with cor pulmonale. About one-third of the cases were initially misdiagnosed and treated as pulmonary tuberculosis. Extra-pulmonary manifestations and comorbidities were also evident in our series. This systematic review helps to determine epidemiological and clinical characteristics of pulmonary alveolar microlithiasis. Further research is needed to elucidate the etiopathogenesis, diagnosis, and therapeutic options, which are beneficial in developing and identifying cost-effective treatment for pulmonary alveolar microlithiasis.

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Pulmonary alveolar microlithiasis with calcified pleural plaques

Cited by 14 publications

References 9 publications

First Presentation of a Case of Pulmonary Alveolar Microlithiasis with Spontaneous Pneumothorax

First Presentation of a Case of Pulmonary Alveolar Microlithiasis with Spontaneous Pneumothorax

Pulmonary Alveolar Microlithiasis and Preterm Delivery: A Case Report

Pulmonary alveolar microlithiasis: an interesting case report with systematic review of Indian literature

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