A 39-year-old female patient, Peruvian, radiated in Chile for 15 years, with no morbid history, non-smoking.
She was referred to a physician with a history of several months of progressive dyspnea, accentuated in the context of an acute febrile respiratory condition that was managed on an outpatient basis with antibiotics and corticosteroids.
The response to treatment was partial, with regression of the fever but with persistent dyspnea on exertion, so he consulted at the National Thoracic Institute.
In the first evaluation, the patient presented saturation by pulse oximetry 96%, breathing ambient air, with no relevant findings in the general or segmental physical examination.
Pulmonary function tests showed 91% forced vital capacity (FVC), 99% forced expiratory volume in one second (FEV-1) and 62% lung diffusion capacity (LDCO).
The chest X-ray showed diffuse ground-glass opacity, predominantly in the lung bases, with areas more often affected than not producing signs of the silhouette with the heart.
High-resolution computed tomography (CT) of the chest showed numerous thickened pulmonary bases, predominantly calcified with subpleural glazing, in greater quantity in the anterior segments of the upper lobes, and posterior glazing.
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She was directly questioned about environmental or occupational exposures and a laboratory study of rheumatologic diseases was conducted, all of which was negative.
Plasma calcium, phosphorus and albumin levels were normal.
The patient was studied with fiberoptic bronchoscopy, which showed no macroscopic changes, with bronchoalveolar lavage without diagnostic findings.
Microbiological study with current culture, sputum smear microscopy and culture of Löstein-Jensen were negative.
Finally, a lung biopsy was performed by videothoracoscopy.
In the macroscopic study, fragments of lungs with folded and translucency were observed, with yellow pulmonary parenchyma, with fine granular appearance.
The microscopic study revealed a lung with normal interlobular septa and septa, of preserved architecture, with thin alveolar walls, with partial and diffuse occupation of the alveolar air space by calcifying calcifications.
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Considering the clinical picture, the imaging findings and the biopsy result, the diagnosis is pulmonary alveolar microlithiasis.
