{"title":"Pulmonary Alveolar Microlithiasis Scintigraphic Features","authors":"J. Hephzibah, R. Oommen, Bala Mugesh, J. Pradhip","doi":"10.5580/2506","DOIUrl":null,"url":null,"abstract":"A 35-year-old female patient presented with a history of nonspecific chest pain and cough for one year. Spirometric studies excluded an obstructive ventilatory defect . Lung volume study findings were consistent with a moderate restrictive ventilatory defect with Total Lung capacity of 2.15L (51.6% of predicted). Diffusing capacity for the alveolar volume ventilated was reduced. Plain chest radiograph showed sand-like opacities, diffusely scattered, bilateral, micronodular areas of radioopacity of calcific densities throughout the lungs with the classic “sandstorm” pattern throughout both lungs predominantly in the lower zones (Fig: 1). Figure 1 Figure 1: Plain chest radiograph showing sand-like opacities, diffusely scattered, bilateral, micronodular areas of radioopacity of calcific densities throughout the lungs with the classic “sandstorm” pattern throughout both lungs predominantly in the lower zones. Computerized tomographic scan revealed diffuse bilateral calcified fine nodular pattern with extensive septal thickening (Fig: 2). Pulmonary Alveolar Microlithiasis Scintigraphic Features 2 of 4 Figure 2 Figure 2: Computerized tomographic scan showing diffuse bilateral calcified fine nodular pattern with extensive septal thickening. Figure 3 Figure 3: Tc-99m methylene diphosphonate (MDP) Bone scintigraphy showing intense bilateral uptake of the radiopharmaceutical in the lungs. Bone scintigraphy along with chest radiography and computerized tomography contributed to the diagnosis of Pulmonary Alveolar Microlithiasis in this patient. DISCUSSION Pulmonary alveolar microlithiasis is a rare disease of unknown etiology, characterized by the presence of calcific concretions in the alveolar spaces, intra-alveolar development and deposition of microliths or calcispherytes consisting of calcium phosphate1 The progression of the disease is generally very slow. Study of the calcium metabolism in many reported cases, however, reveals no derangement of serum calcium levels as in this patient who was normocalcemic, though elevated serum calcium and renal stones have been recorded in some cases.2, 3 Pulmonary function studies demonstrate a tendency toward a restrictive pattern. Chest roentgenography, high-resolution computed tomographic, and technetium-99m lung scan are useful in the diagnosis. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray. Bone scintigraphy may add helpful information in the case of nonspecific CT findings. Bone scan usually shows intense bilateral uptake of the radiopharmaceutical in the lungs.4 Differential diagnosis of diffuse lung uptake in bone scans includes patients with hyperparathyroidism, Hodgkins lymphoma, Sarcoidosis, Wegener's vasculitis, Primary amyloid, renal failure and Pneumocystis carinii.5 CORRESPONDENCE TO Dr Regi Oommen MD, Professor and Head, Department of Nuclear Medicine, Christian Medical College, Vellore - 632004, India. Email ID: regi@cmcvellore.ac.in Fax: 0091-416-2232103 References 1. Moran CA, Hochholzer L, Hasleton PS, Johnson FB, Koss MN. Pulmonary alveolar microlithiasis: a clinicopathologic and chemical analysis of seven cases. Arch Pathol Lab Med 1997;121:607-611 2. Badger, T. L., Gottlieb. L. and Gaensler, E. A.: Pulmonary alveolar microlithiasis or calcinosis of lungs. New Engl. J. Med., 253: 709-715, 1955. 3. Portnoy, L. M., Amadeo, B. and Hennigar, G. R.: Pulmonary alveolar microlithiasis. An unusual case associated with milk alkali syndrome. Amer. J. Clin. Pathol., 41: 194-201, 1964. 4. Pulmonary Alveolar Microlithiasis: Radiographic and Scintigraphic Correlation. Shah, Tanmaya C.; Talwar, Arunabh; Shah, Rakesh D. ; Margouleff, Donald Clinical Nuclear Medicine. 32(3):249-25, 2007. 5. James P Strain, Anthony Parker, Kevin Donohoe et al: Pulmonary Alveolar Microlithiasis Scintigraphic Features 3 of 4 Diffuse intense lung uptake on a bone scan: A case report. Clinical Nuclear Medicine. 25(8): 608 -610, 2000. Pulmonary Alveolar Microlithiasis Scintigraphic Features 4 of 4 Author Information Julie Hephzibah, MD, DNB Department of Nuclear Medicine, Christian Medical College Regi Oommen, DMRT, MD, DRM Department of Nuclear Medicine, Christian Medical College Bala Mugesh, MD DM Department of Pulmonary Medicine, Christian Medical College Joe Pradhip, DMRD, DNB Department of Radiology, Christian Medical College","PeriodicalId":284620,"journal":{"name":"The Internet Journal of Pulmonary Medicine","volume":"442 1-2 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2006-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Internet Journal of Pulmonary Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5580/2506","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
A 35-year-old female patient presented with a history of nonspecific chest pain and cough for one year. Spirometric studies excluded an obstructive ventilatory defect . Lung volume study findings were consistent with a moderate restrictive ventilatory defect with Total Lung capacity of 2.15L (51.6% of predicted). Diffusing capacity for the alveolar volume ventilated was reduced. Plain chest radiograph showed sand-like opacities, diffusely scattered, bilateral, micronodular areas of radioopacity of calcific densities throughout the lungs with the classic “sandstorm” pattern throughout both lungs predominantly in the lower zones (Fig: 1). Figure 1 Figure 1: Plain chest radiograph showing sand-like opacities, diffusely scattered, bilateral, micronodular areas of radioopacity of calcific densities throughout the lungs with the classic “sandstorm” pattern throughout both lungs predominantly in the lower zones. Computerized tomographic scan revealed diffuse bilateral calcified fine nodular pattern with extensive septal thickening (Fig: 2). Pulmonary Alveolar Microlithiasis Scintigraphic Features 2 of 4 Figure 2 Figure 2: Computerized tomographic scan showing diffuse bilateral calcified fine nodular pattern with extensive septal thickening. Figure 3 Figure 3: Tc-99m methylene diphosphonate (MDP) Bone scintigraphy showing intense bilateral uptake of the radiopharmaceutical in the lungs. Bone scintigraphy along with chest radiography and computerized tomography contributed to the diagnosis of Pulmonary Alveolar Microlithiasis in this patient. DISCUSSION Pulmonary alveolar microlithiasis is a rare disease of unknown etiology, characterized by the presence of calcific concretions in the alveolar spaces, intra-alveolar development and deposition of microliths or calcispherytes consisting of calcium phosphate1 The progression of the disease is generally very slow. Study of the calcium metabolism in many reported cases, however, reveals no derangement of serum calcium levels as in this patient who was normocalcemic, though elevated serum calcium and renal stones have been recorded in some cases.2, 3 Pulmonary function studies demonstrate a tendency toward a restrictive pattern. Chest roentgenography, high-resolution computed tomographic, and technetium-99m lung scan are useful in the diagnosis. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray. Bone scintigraphy may add helpful information in the case of nonspecific CT findings. Bone scan usually shows intense bilateral uptake of the radiopharmaceutical in the lungs.4 Differential diagnosis of diffuse lung uptake in bone scans includes patients with hyperparathyroidism, Hodgkins lymphoma, Sarcoidosis, Wegener's vasculitis, Primary amyloid, renal failure and Pneumocystis carinii.5 CORRESPONDENCE TO Dr Regi Oommen MD, Professor and Head, Department of Nuclear Medicine, Christian Medical College, Vellore - 632004, India. Email ID: regi@cmcvellore.ac.in Fax: 0091-416-2232103 References 1. Moran CA, Hochholzer L, Hasleton PS, Johnson FB, Koss MN. Pulmonary alveolar microlithiasis: a clinicopathologic and chemical analysis of seven cases. Arch Pathol Lab Med 1997;121:607-611 2. Badger, T. L., Gottlieb. L. and Gaensler, E. A.: Pulmonary alveolar microlithiasis or calcinosis of lungs. New Engl. J. Med., 253: 709-715, 1955. 3. Portnoy, L. M., Amadeo, B. and Hennigar, G. R.: Pulmonary alveolar microlithiasis. An unusual case associated with milk alkali syndrome. Amer. J. Clin. Pathol., 41: 194-201, 1964. 4. Pulmonary Alveolar Microlithiasis: Radiographic and Scintigraphic Correlation. Shah, Tanmaya C.; Talwar, Arunabh; Shah, Rakesh D. ; Margouleff, Donald Clinical Nuclear Medicine. 32(3):249-25, 2007. 5. James P Strain, Anthony Parker, Kevin Donohoe et al: Pulmonary Alveolar Microlithiasis Scintigraphic Features 3 of 4 Diffuse intense lung uptake on a bone scan: A case report. Clinical Nuclear Medicine. 25(8): 608 -610, 2000. Pulmonary Alveolar Microlithiasis Scintigraphic Features 4 of 4 Author Information Julie Hephzibah, MD, DNB Department of Nuclear Medicine, Christian Medical College Regi Oommen, DMRT, MD, DRM Department of Nuclear Medicine, Christian Medical College Bala Mugesh, MD DM Department of Pulmonary Medicine, Christian Medical College Joe Pradhip, DMRD, DNB Department of Radiology, Christian Medical College