Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences

Pulmonary Alveolar Microlithiasis

Constantinos Glynos1, Nikolaos Papathanasiou2, Ioanna Nikoloutsou1, and Georgios T. Stathopoulos1
Departments of 1Critical Care and Pulmonary Services and 2Nuclear Medicine, General Hospital Evangelismos, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

Figure 1. We present images obtained immediately pre-mortem from a 60-year-old woman with long-standing pulmonary alveolar microlithiasis. Posterior anterior digital chest radiograph (Figure 1A) exhibits the characteristic bilateral diffuse micronodular sandstorm radiographic pattern. Chest computed tomography (Figure 1B) shows bilateral conuent micronodular parenchymal and pleural calcication (left; soft-tissue window; white arrows), and interstitial thickening/brosis (right; lung parenchymal window; additional opacities). Whole-body 99mTechenetium-methylene diphosphonate scintigraphy (Figure 1C) shows diffusely increased radiotracer uptake over the lungs (arrows). Microlithiasis has been linked to mutations in the alveolar phosphate-sodium co-transporter SLC34A2 (1). The pathophysiology of calcium phosphate deposition in the alveolar spaces is reviewed elsewhere (2).
Author Disclosure: None of the authors has a nancial relationship with a commercial entity that has an interest in the subject of this manuscript.

References
1. Huqun IS, Miyazawa H, Ishii K, Uchiyama B, Ishida T, Tanaka S, Tazawa R, Fukuyama S, Tanaka T, Nagai Y, et al. Mutations in the SLC34A2 gene are associated with pulmonary alveolar microlithiasis. Am J Respir Crit Care Med 2007;175:263268. 2. Chan ED, Morales DV, Welsh CH, McDermott MT, Schwarz MI. Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med 2002;165:16541669.

Am J Respir Crit Care Med Vol 184. p 740, 2011 DOI: 10.1164/rccm.201101-0186IM Internet address: www.atsjournals.org