Pulmonary alveolar microlithiasis with low fluorodeoxyglucose accumulation in PET/computed tomography

Abstract

Pulmonary alveolar microlithiasis (PAM) is an uncommon lung disease characterized by accumulation of intraalveolar calcifications. The disease can be diagnosed based on the radiological findings. We present a 27-year-old women with five-year history of shortness of breath. She was diagnosed with PAM due to the presence of the characteristic chest X-ray and thorax computed tomography (CT) findings. We performed 18F-fluorodeoxyglucose (FDG)-PET/CT imaging in order to detect any evidence of inflamation in the lung before deciding an anti-inflammatory treatment. The lung regions with dense calcifications revealed low FDG uptakes (SUVmax: 2.7) and the lung regions without calcifications showed lower FDG uptakes. No further treatment modality was planned besides inhaler salbutamol. Herein, we discuss this rare entity with literature search.

Bilateral Micronodular Pulmonary Infiltrate: Is It Important to Make a Histological Diagnosis?

“…Positron emission tomography/CT has no definite role in establishing the diagnosis; however, some studies have looked at possible high standard uptake value at calcific sites, suggesting the role of inflammation and justifying anti-inflammatory medicines, without clear therapeutic benefit. 15,16 Several attempts have been made to treat this disorder, without satisfactory results. Systemic steroids, calcium chelating agent, and repeated bronchoalveolar lavage to remove microliths have been shown to be ineffective, and are used as a palliative measure.…”

Pulmonary Alveolar Microlithiasis with Atypical Radiologic Feature: A Rare Differential Diagnosis of Pulmonary Alveolar Proteinosis in a Patient with Hematologic Malignancy: Case Report

“…1,5 Familial occurrence has been observed in 50 % of Japanese, 48% of Turkish, 43.7 % of Italian patients, whereas 35.6 % cases of PAM have familial presentation worldwide. 3,6 Radiologically, the chest X-ray, CT, or highresolution CT findings are often diagnostic. The chest radiography of PAM characteristically shows infiltrates as fine sand-like calcific micronodules also called ''sandstorm lung''.…”

“…1 Many patients have no clinical symptoms and, generally, the diagnosis is incidental. 1,3 The clinical symptoms usually emerge between third and fourth decades. The most common symptoms are dyspnea, dry cough, chest pain, sporadic hemoptysis, and asthenia.…”

“…However, most cases of PAM have been reported from Turkey, Japan and Italy. 3 PAM is generally diagnosed from birth to 40 years of age and does not have sex predilection. In a report analyzing 576 patients, 35,8% of patients were under twenty years of age and 88,2% were under fifty.…”

“…Although the radiographic appearance is pathognomonic, in some cases, clinical and radiological findings may be misdiagnosed as miliary tuberculosis. 3,6 Therefore, diagnosis of the disease should be verified by histological examination of the lung biopsy.…”