Pulmonary Alveolar Microlithiasis Scintigraphic Features

J. Hephzibah, R. Oommen, Bala Mugesh, J. Pradhip
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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
肺泡微石症的影像学特征
女性,35岁,有非特异性胸痛和咳嗽病史一年。肺活量测定排除了阻塞性通气缺陷。肺容量研究结果与中度限制性通气缺陷一致,总肺容量为2.15L(预测的51.6%)。肺泡容积通气的扩散能力降低。胸片平片示沙质样混浊,弥漫性散在,双侧,微结节状钙化密度放射性混浊区,两肺均可见典型的“沙暴”型混浊,主要表现在肺下部(图1)。胸片平片示沙质样混浊,弥漫性散在,双侧,小结节状钙化密度放射性混浊区,贯穿两肺,典型的“sandstorm”型混浊区主要位于肺下区。计算机断层扫描显示双侧弥漫性钙化细结节型伴广泛间隔增厚(图2)。肺泡微石症扫描特征2 / 4图2图2:计算机断层扫描显示双侧弥漫性钙化细结节型伴广泛间隔增厚。图3:Tc-99m二膦酸亚甲基(MDP)骨显像显示双侧肺部强烈的放射性药物摄取。骨显像、胸片和计算机断层扫描有助于诊断该患者的肺泡微石症。肺泡微石症是一种病因不明的罕见疾病,其特征是肺泡间隙存在钙化结块,肺泡内发育和沉积微石或由磷酸钙组成的钙化细胞1,疾病进展通常非常缓慢。然而,对许多报告病例的钙代谢研究显示,尽管在一些病例中记录了血清钙升高和肾结石,但没有像本例正常血钙血症患者那样出现血清钙水平紊乱。2,3肺功能研究显示有限制型的倾向。胸部x线摄影,高分辨率计算机断层扫描和99m肺扫描对诊断有用。骨显像可用于检测早期肺钙化,这些钙化与肺功能受损有关,由于其大小,通常无法通过x射线检测到。骨显像可以在非特异性CT表现的情况下提供有用的信息。骨扫描通常显示双侧肺部强烈的放射性药物摄取骨扫描中弥漫性肺摄取的鉴别诊断包括甲状旁腺功能亢进、霍奇金淋巴瘤、结节病、韦格纳血管炎、原发性淀粉样蛋白、肾功能衰竭和卡氏肺囊虫印度基督教医学院核医学系教授兼系主任Regi Oommen博士,Vellore - 632004。Email ID: regi@cmcvellore.ac.in传真:00911-416-2232103参考文献Moran CA, Hochholzer L, Hasleton PS, Johnson FB, Koss MN。肺泡微石症:7例临床病理及化学分析。医学病理学杂志1997;121:607-611 2。獾,t.l.,戈特利布。L.和Gaensler, E. A:肺泡微石症或肺钙质沉着症。新英格兰。中华医学杂志,25(3):739 -715,1995。3.Portnoy, L. M., Amadeo, B.和Hennigar, G. R.:肺泡微石症。与乳碱综合征相关的罕见病例。阿米尔。j .中国。病理学研究。科学通报,41(1):194-201,1964。4. 肺泡微石症:x线摄影与星形摄影的相关性。Shah, Tanmaya C.;三、Arunabh;Shah, Rakesh D.;杨建军,刘建军。核医学杂志。32(3):249- 25,2007。5. James P Strain, Anthony Parker, Kevin Donohoe等:肺泡微石症的影像学特征:骨扫描上弥漫性强烈肺摄取1例。临床核医学,25(8):608 -610,2000。肺泡微石症科学特征4 / 4作者信息Julie Hephzibah, MD, DNB基督教医学院核医学系Regi Oommen, DMRT, MD, DRM基督教医学院核医学系Bala Mugesh, MD基督教医学院肺医学系Joe Pradhip, DMRD, DNB基督教医学院放射科
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