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Diffuse hyperdense micronodular airspace opacities in pulmonary alveolar microlithiasis
  1. Akshay Mathavan1,
  2. Akash Mathavan1,
  3. Cordelia Witten1,
  4. Ali Ataya2
  1. 1 Internal Medicine, University of Florida, Gainesville, Florida, USA
  2. 2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Ali Ataya, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL 32610, USA; ali.ataya{at}

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A 44-year-old woman with a childhood history of pulmonary tuberculosis presented with mild exertional dyspnoea and abnormal chest radiographic imaging (figure 1) obtained at an external facility, which showed diffuse, fine calcific micronodules throughout the lung parenchyma. She was informed of an incidental finding of ‘lung disease’ 15 years prior after a motor vehicle accident, for which she was unable to obtain follow-up. She had no other symptoms; physical examination and laboratory results were unremarkable. Chest CT imaging (figure 2) demonstrated diffuse hyperdense micronodular airspace opacities indicative of pulmonary alveolar microlithiasis (PAM). Pulmonary function testing showed restrictive ventilatory defects with a diffusing capacity for carbon monoxide of 28%. Testing for tuberculosis was negative. Transbronchial biopsies performed at an external facility revealed intra-alveolar lamellar spherules, confirming PAM. Over 4 years, the patient experienced worsening exertional dyspnoea, requiring oxygen therapy, leading to bilateral lung transplantation, after which she remained clinically stable for 6 years.

Figure 1

Anteroposterior (A) and lateral (B) radiographic imaging of the chest demonstrating …

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  • Contributors AyM and AhM performed literature review and drafted the manuscript. CW assisted with literature review and drafting portions of the manuscript. AA supervised the manuscript, provided subject matter expertise, revised the manuscript, and is responsible for the final content. All authors have agreed on the journal to which the article will be submitted, the final version for publication, and accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.