1
|
Hizal M, Gunel IE, Ozcan HN, Oguz B, Emiralioglu N, Yalcin E, Dogru D, Ozcelik U, Haliloglu M, Kiper N. Comparison of lung ultrasonography and magnetic resonance imaging versus computed tomography in pulmonary alveolar microlithiasis. Pediatr Pulmonol 2024. [PMID: 38214437 DOI: 10.1002/ppul.26862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Mina Hizal
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ilkin E Gunel
- Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hatice N Ozcan
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
Sarkar M, Sharma SK, Jhobta A, Gulati A. A case report of pulmonary alveolar microlithiasis with pulmonary tuberculosis. Lung India 2023; 40:161-164. [PMID: 37006101 PMCID: PMC10174655 DOI: 10.4103/lungindia.lungindia_276_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/09/2023] [Indexed: 03/05/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterised by the deposition of calcium phosphate microliths in the alveoli. PAM has been reported in all continents and there is often a familial history. There is clinical-radiological dissociation as there is often a paucity of symptoms in contrast to the imaging findings. Patients often remain asymptomatic until the third or fourth decade of life, and dyspnea is the most common symptom. PAM is caused by a mutation within the solute carrier family 34 member 2 gene (the SLC34A2 gene) located on chromosome 4p15.2, which encodes a sodium/phosphate co-transporter. The imaging appearance of the disease is quite pathognomic with the high-resolution computed tomography (HRCT) demonstrating a diffuse micronodular appearance. Transbronchial lung biopsy also confirms the diagnosis. There is no effective therapy at present except lung transplantation. We herein, present a case of PAM along with clinical history, imaging study, histopathological study and genetic study of a 43-year-old female adult patient along with genetic analysis.
Collapse
Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sudarshan K. Sharma
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anchana Gulati
- Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|
3
|
Samrah S, Shraideh H, Rawashdeh S, Khassawneh B. Tricuspid valve calcification in familial pulmonary alveolar microlithiasis: A case report. Ann Med Surg (Lond) 2020; 55:256-259. [PMID: 32528675 PMCID: PMC7281303 DOI: 10.1016/j.amsu.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/05/2023] Open
Abstract
Background Pulmonary Alveolar Microlithiasis (PAM) is an uncommon, gradually progressive and eventually fatal hereditary disease that affects young population. Familial cases account for up to 50% of reported cases. There are few described cases of extrapulmonary manifestations of PAM and rare reports of cardiac involvement. Case report A 45-year-old male patient presented to our center with progressive shortness of breath and dry cough. On physical examination, he was tachypneic and chest examination revealed diminished breath sounds with bilateral early inspiratory crackles. Further workup revealed the diagnosis of PAM. Echocardiography revealed calcifications covering the tricuspid valve with elevated right ventricular systolic pressure. He reported having two sisters with similar illnesses and chest radiographic abnormalities, one died at the age of 38 years from respiratory failure and the other is 42-year-old and still alive and was diagnosed with PAM. Another 35 member of his family were diagnosed with PAM. Unfortunately, few days after discharge, he arrested at home. Conclusions Recently, type-II sodium/phosphate co-transporter has been identified in a human aortic valve. Studies have suggested penetrance of mutations of SLC34A2 gene might explain such variability of pulmonary and extrapulmonary involvement. Our case reports a familial cluster of PAM, and the first case of concomitant tricuspid calcification. This finding might be a useful in the investigation for a future genetic targeted therapy. PAM is a fatal hereditary disease that affects young population. There are few described cases of extrapulmonary manifestations of PAM. Mutations of SLC34A2 gene might explain variability of extrapulmonary involvement.
Collapse
Affiliation(s)
- Shaher Samrah
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Sukiana Rawashdeh
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basheer Khassawneh
- Department of Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
4
|
Haddad RM, Al-Momani JA, Al-Omari AH, AlSuleihat AS, Alnadi KM, Alsaidah N, Alelaimat AF, Obeidat TA. Pulmonary Alveolar Microlithiasis: a Case Report in King Hussein Medical Center (KHMC), Amman, Jordan. Med Arch 2020; 74:69-72. [PMID: 32317840 PMCID: PMC7164730 DOI: 10.5455/medarh.2020.74.69-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Pulmonary Alveolar Microlithiasis (PAM) is a rare disorder that can affect patients at any age, although it is more common to present in the third and fourth decades of life. Most patients are asymptomatic at the time of diagnosis. However, some may present with symptoms of dyspnea or cough. PAM can be sporadic, or it can be hereditary. Aim: To focus on the importance of using chest CT scans along with bone scintigraphy to aid in the diagnosis of PAM. The importance of screening all family members is also addressed. Case report: In our case, the patient was a 21-year-old male, coming for routine check-up to be recruited in the army. He was referred to our clinic after the examining doctor noticed that his chest X-Ray was not normal. Upon revising his chest X-ray, he was found to have bilateral fine reticular infiltrates. His physical examination was unremarkable. His spirometry and DLCO were normal. A high-resolution chest CT scan was done, and showed diffuse bilateral microcalcifications with bilateral interstitial and septal thickening. To confirm the diagnosis of PAM, a Technetium-99m methylene diphosphonate (Tc-99m MDP) whole body bone scintigraphy was done, and it showed diffusely increased radiotracer uptake in both lungs. His family members were screened for PAM. His father and sister, who were completely asymptomatic and with normal pulmonary function tests, were found to have PAM as well. Conclusion: The use of bone scintigraphy plays an integral role in diagnosing patients with radiological findings consistent with PAM, and it can diagnose PAM without the need for invasive procedures. Once diagnosed, screening of all family members for PAM should be done, even when they are asymptomatic, as more than one-third of the cases have a familial pattern.
Collapse
Affiliation(s)
- Rakan M Haddad
- Department of Internal Medicine, Respiratory Medicine Division, King Hussein Medical Center (KHMC), Amman, Jordan
| | - Jafar A Al-Momani
- Department of Internal Medicine, Respiratory Medicine Division, King Hussein Medical Center (KHMC), Amman, Jordan
| | - Abdullah H Al-Omari
- Department of Diagnostic Radiology, King Hussein Medical Center (KHMC), Amman, Jordan
| | - Adnan S AlSuleihat
- Department of Internal Medicine, Respiratory Medicine Division, King Hussein Medical Center (KHMC), Amman, Jordan
| | - Khaled M Alnadi
- Department of Internal Medicine, Respiratory Medicine Division, King Hussein Medical Center (KHMC), Amman, Jordan
| | - Nizar Alsaidah
- Department of Urology, Prince Hussein Urology Center, KHMC, Amman, Jordan
| | | | - Tamara Ahmad Obeidat
- Department of Diagnostic Radiology, King Hussein Medical Center (KHMC), Amman, Jordan
| |
Collapse
|
5
|
Chopra M, Tendolkar MS, Vardhan V. Case series of Pulmonary Alveolar Microlithiasis from India. BMJ Case Rep 2019; 12:12/3/e227406. [PMID: 30904891 DOI: 10.1136/bcr-2018-227406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by calcific deposits in lung parenchyma. PAM being a progressive disease with dissociation between severity of clinical symptoms and radiological picture, it is often detected incidentally. Mutations in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells are considered to be involved in the pathogenesis of PAM. The majority of the patients are diagnosed usually between the ages of 20 and 40 years, although paediatric PAM has also been reported. Diagnosis is confirmed by combination of radiological features, bronchial lavage and histopathological testing. At present, lung transplant is the only definitive treatment available. Though rare, the prevalence of PAM is worldwide. Till June 2018, 86 cases have been reported from India and 1042 cases have been reported worldwide. We report three cases from India, including a student, cement factory worker and a tailor, which will highlight the varied clinical and radiological presentations of this rare disease along with the response to treatment.
Collapse
Affiliation(s)
- Manu Chopra
- Department of Pulmonary Medicine, Army Hospital - Research and Referral, New Delhi, Delhi, India
| | - Manjit Sharad Tendolkar
- Department of Pulmonary Medicine, Indian Naval Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Vasu Vardhan
- Department of Pulmonary Medicine, Army Hospital - Research and Referral, New Delhi, Delhi, India
| |
Collapse
|
6
|
Zaghba N, Hachimi KE, Benjelloun H, Yassine N. [Alveolar microlithiasis: about a new case]. Pan Afr Med J 2018; 28:241. [PMID: 29881486 PMCID: PMC5989273 DOI: 10.11604/pamj.2017.28.241.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022] Open
Abstract
Alveolar microlithiasis (AM) is a rare disease, characterized by the accumulation of calcium concretions in the pulmonary alveolar lumen. We report a new case of AM suspected on chest X-ray and confirmed by chest CT scan, whose appearance was pathognomonic, and by transbronchial pulmonary biopsy. AM is often asymptomatic, contrasting with the importance of lesions on X-ray which are characteristics of this disease. The cause of this disease is unknown. However autosomal recessive inheritance with mutation in the SLC34A2 gene is suspected.
Collapse
Affiliation(s)
- Nahid Zaghba
- Service des Maladies Respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - Kawtar El Hachimi
- Service des Maladies Respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - Hanane Benjelloun
- Service des Maladies Respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - Najiba Yassine
- Service des Maladies Respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| |
Collapse
|
7
|
Gupta PK, Mittal R, Chhabra SK. Calcified pulmonary consolidations in pulmonary alveolar microlithiasis: Uncommon computed tomographic appearance of a rare disease. Lung India 2017; 34:297-299. [PMID: 28474663 PMCID: PMC5427765 DOI: 10.4103/0970-2113.205336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pawan K Gupta
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Richa Mittal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sunil K Chhabra
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| |
Collapse
|
8
|
Castellana G, Castellana G, Gentile M, Castellana R, Resta O. Pulmonary alveolar microlithiasis: review of the 1022 cases reported worldwide. Eur Respir Rev 2016; 24:607-20. [PMID: 26621975 PMCID: PMC9487614 DOI: 10.1183/16000617.0036-2015] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by the widespread intra-alveolar accumulation of minute calculi called microliths. It is caused by mutation of the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. The present study explores the epidemiological, familial, genetic, clinical, diagnostic, radiological and therapeutic aspects with the aim of contributing to a better understanding of this uncommon disease. We searched articles on PAM published up to December 2014 and 544 papers were found, accounting for 1022 cases. PAM is present in all continents and in many nations, in particular in Turkey, China, Japan, India, Italy and the USA. Familiality is frequent. The clinical course is not uniform and the causes of this clinical variability seem to be largely nongenetic. The optimal diagnostic procedure is the association of chest high-resolution computed tomography (HRCT) with bronchoalveolar lavage, but a chest radiograph may suffice in families in which a case has already been diagnosed. Moreover, chest radiography and HRCT allow the classification of the evolutionary phase of the disease and its severity. At present lung transplantation is the only effective therapy. However, better knowledge of the gene responsible offers hope for new therapies. Familial, genetic, clinical, radiological and therapeutic aspects of pulmonary alveolarmicrolithiasis epidemiologyhttp://ow.ly/St3Mw
Collapse
Affiliation(s)
| | - Giorgio Castellana
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
| | - Mattia Gentile
- Medical Genetics Unit, Azienda Sanitaria Locale Bari, Bari, Italy
| | | | - Onofrio Resta
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
| |
Collapse
|
9
|
de Almeida RR, Zanetti G, Pereira E Silva JL, Neto CAA, Gomes ACP, Meirelles GDSP, da Silva TKB, Nobre LF, Hochhegger B, Escuissato DL, Marchiori E. Respiratory Tract Amyloidosis. State-of-the-Art Review with a Focus on Pulmonary Involvement. Lung 2015; 193:875-83. [PMID: 26310967 DOI: 10.1007/s00408-015-9791-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
Amyloidosis is a constellation of disease entities characterized by abnormal extracellular deposition and accumulation of protein and protein derivatives, which show apple-green birefringence when stained with Congo red and viewed under polarized light. Amyloid can infiltrate virtually all organ systems and can display multiple and diverse imaging findings. Pathologically, respiratory involvement occurs in 50 % of patients with amyloidosis, and its clinical signs and symptoms vary depending on whether the disease is systemic or localized. The four main patterns of respiratory tract involvement are tracheobronchial, nodular parenchymal, diffuse alveolar septal, and lymphatic. Imaging findings of amyloidosis are nonspecific and vary in each pattern; knowledge about the disease impairment type is thus very important, and amyloidosis should be considered in the differential diagnosis of other very common diseases, such as infectious diseases, neoplasms, and vasculitis. This literature review describes the main clinical and imaging manifestations of amyloidosis, focusing on respiratory tract involvement and differential diagnosis.
Collapse
Affiliation(s)
- Renata Rocha de Almeida
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil
| | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil
| | | | | | | | | | | | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil.
| |
Collapse
|
10
|
Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The 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 METHODS Thirteen 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. RESULTS Ground-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%). CONCLUSION As 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.
Collapse
Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
11
|
Ganesan N, Ambroise MM, Ramdas A, Kisku KH, Singh K, Varghese RGB. Pulmonary alveolar microlithiasis: an interesting case report with systematic review of Indian literature. Front Med 2015; 9:229-38. [PMID: 26024716 DOI: 10.1007/s11684-015-0394-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Nidhya Ganesan
- Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, 605014, India,
| | | | | | | | | | | |
Collapse
|
12
|
Rittayamai N, Muangman N, Ruangchira-Urai R. Extensive pulmonary alveolar microlithiasis. Respirol Case Rep 2014; 2:4-6. [PMID: 25473548 PMCID: PMC4184717 DOI: 10.1002/rcr2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/11/2013] [Indexed: 12/03/2022] Open
Abstract
Pulmonary alveolar microlithiasis is a rare pulmonary disorder that is caused by abnormal sodium-dependent phosphate co-transporter from the mutation of SLC34A2 gene, leading to accumulation of microliths in the alveoli. We report the extensive pulmonary alveolar microlithiasis in an elderly woman who presented with progressive dyspnea for 2 months. Chest radiograph revealed diffuse pulmonary calcification. Tissue histopathology from open lung biopsy demonstrated widespread intra-alveolar laminated calcium deposits compatible with pulmonary alveolar microlithiasis.
Collapse
Affiliation(s)
- Nuttapol Rittayamai
- Division of Respiratory Diseases and Tuberbulosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Nisa Muangman
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| | - Ruchira Ruangchira-Urai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand
| |
Collapse
|
13
|
Sigari N, Nikkhoo B. First presentation of a case of pulmonary alveolar microlithiasis with spontaneous pneumothorax. Oman Med J 2014; 29:450-3. [PMID: 25584164 PMCID: PMC4289487 DOI: 10.5001/omj.2014.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/24/2013] [Indexed: 01/06/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Naseh Sigari
- Department of Internal Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bahram Nikkhoo
- Department of Pathology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
14
|
Ch'ng LS, Bux SI, Liam CK, Rahman NA, Ho CY. Sandstorm appearance of pulmonary alveolar microlithiasis incidentally detected in a young, asymptomatic male. Korean J Radiol 2013; 14:859-62. [PMID: 24043987 PMCID: PMC3772273 DOI: 10.3348/kjr.2013.14.5.859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 06/27/2013] [Indexed: 11/21/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.
Collapse
Affiliation(s)
- Li Shyan Ch'ng
- Department of Biomedical Imaging, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur 50603, Malaysia
| | | | | | | | | |
Collapse
|
15
|
|
16
|
Imaging calcific concretions of pulmonary alveolar microlithiasis with PET: insight into disease pathophysiology. Clin Nucl Med 2012; 37:707-8. [PMID: 22691522 DOI: 10.1097/rlu.0b013e318251dfd0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A case of 18F-FDG PET in pulmonary alveolar microlithiasis with bilateral reticulonodular opacities in the middle and lower zones on routine chest roentgenogram and calcification in the peribronchovascular interstitium,peribronchovascular and subpleural intralobular septal regions, and visceral pleura on high-resolution chest CT is presented. 18F-fluoride PET demonstrated intense tracer uptake in the lower zone of both lungs corresponding to CT findings. Minimal FDG activity in areas of dense calcification suggests minimal or no inflammation. This could account for the absence of symptoms in most cases despite remarkable imaging findings.
Collapse
|
17
|
Singh M, Saini AG, Mathew J, Nahar U, Vaiphei K. Pulmonary Alveolar Microlithiasis in Children: Case Series and Review of Literature. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:221-224. [PMID: 35927861 DOI: 10.1089/ped.2011.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pulmonary alveolar microlithiasis is rare in children. It presents as a chronic disease with early asymptomatic course and is usually idiopathic. Characteristic radiology and high index of suspicion can lead to early diagnosis by lung biopsy. Treatment with drugs targeting phosphate metabolism may be beneficial. We present a series of 3 pediatric cases confirmed by lung biopsies, along with review of literature.
Collapse
Affiliation(s)
- Meenu Singh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi G Saini
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
18
|
Kang HW, Kim TO, Oh IJ, Kim YI, Lim SC, Choi YD, Song SY, Seon HJ, Kwon YS. A case of pulmonary alveolar microlithiasis. J Korean Med Sci 2011; 26:1391-3. [PMID: 22022196 PMCID: PMC3192355 DOI: 10.3346/jkms.2011.26.10.1391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/02/2011] [Indexed: 11/20/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease with unknown etiology and pathogenesis. It is characterized by diffuse, innumerable, and minute calculi, called microlithiasis in the alveoli. More than half of reported cases are asymptomatic at the time of diagnosis. We describe the first case of PAM in Korea. A 19-yr-old man without respiratory symptoms presented with interstitial thickening on the chest radiograph. His chest high resolution CT scan showed diffusely scattered, ill defined tiny micronodules and interstitial thickening. Open lung biopsy confirmed the diagnosis of PAM. He was followed up for 6 months without treatment, and no progression was noticed.
Collapse
Affiliation(s)
- Hyun Wook Kang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Tae Ok Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Hospital, Gwangju, Korea
| | - Sang-Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| |
Collapse
|
19
|
Affiliation(s)
- Jayakrishnan Krishnakurup
- Section of Geriatric Medicine, Bridgeport Hospital/Yale New Haven Health System, Bridgeport, CT, USA
| | | |
Collapse
|
20
|
Pulmonary alveolar microlithiasis: a case report with emphasis on imaging findings. Case Rep Med 2010; 2010:819242. [PMID: 20671919 PMCID: PMC2910500 DOI: 10.1155/2010/819242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/03/2010] [Accepted: 06/16/2010] [Indexed: 12/12/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The authors report a case of a 21-year-old man with a 2-year history of shortness of breath on exertion and dry cough. Physical examination was altered only for crackles at auscultation. Pulmonary function revealed a mild restrictive ventilatory defect and the chest radiograph demonstrated paracardiac confluence of dense micronodular infiltrate. High-resolution CT scan revealed diffuse ground glass attenuation and septal thickening, more pronounced in lower pulmonary regions, with calcifications along the interlobar septa and subpleural regions. A transbronchial lung biopsy confirmed the diagnosis of PAM.
Collapse
|
21
|
Samano MN, Waisberg DR, Canzian M, Campos SV, Pêgo-Fernandes PM, Jatene FB. Lung transplantation for pulmonary alveolar microlithiasis: a case report. Clinics (Sao Paulo) 2010; 65:233-6. [PMID: 20186308 PMCID: PMC2827711 DOI: 10.1590/s1807-59322010000200016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Marcos Naoyuki Samano
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | | | - Mauro Canzian
- Pathology Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Silvia Vidal Campos
- Lung Transplant Group, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil,
, Tel.: 55 11 3069.5248
| | - Paulo M. Pêgo-Fernandes
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Fabio B. Jatene
- Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| |
Collapse
|
22
|
Chandra S, Mohan A, Guleria R, Das P, Sarkar C. Bilateral stony lung: pulmonary alveolar microlithiasis. BMJ Case Rep 2009; 2009:bcr09.2008.1012. [PMID: 21686505 DOI: 10.1136/bcr.09.2008.1012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 40-year-old male paddy field worker was referred for exertional shortness of breath and non-productive cough for 4 years. He had been treated for pulmonary tuberculosis twice. Chest radiograph showed extensive bilateral nodular opacities ("sandstorm-like") in the middle and lower lobe. Pulmonary function tests revealed a restrictive ventilatory defect. High resolution CT showed widespread nodular infiltration with "crazy paving" appearance and interrupted black pleura sign. This was confirmed as pulmonary alveolar microlithiasis (PAM) by trans-bronchial lung biopsy, which showed normal respiratory lining epithelium with dilated alveolar spaces containing many calcific bodies, some of which showed concentric calcification. The possibilities of silicosis (due to exposure to husk) and tuberculosis, both of which can mimic PAM clinically and radiologically, made this case a diagnostic challenge.
Collapse
Affiliation(s)
- Subhash Chandra
- AIIMS, Department of Medicine, Ansari Nagar, New Delhi, Delhi, 110029, India
| | | | | | | | | |
Collapse
|