case_images: PMC10629246_01
case_images: Chest X-ray, computed tomography, and a microscopic image of bronchoalveolar lavage (BAL) fluid in a 4-year-old male patient diagnosed with pulmonary alveolar microlithiasis. (a) The chest X-ray image shows many small opacities measuring approximately 1 mm in diameter that spread throughout both lung fields. The X-ray intensity of the tube must be increased 3 times the normal value to clearly visualize. (b-e) The chest high-resolution computed tomography images on the lung and mediastinum windows revealed many small opacities measuring approximately 1-2 mm in diameter, with the density of calcification being 120 HU, clustering in the lower parts, creating the "sandstorm" sign or concentrating to create the "stone lung" sign (white circle); wall thickening and narrowing of the bronchial branches, including both lobar and segmental bronchi (black arrowheads); reticular interstitial thickening around the bronchioles in both lungs (black oval), calcification of the pericardium, interlobar fissures, and the pleura close to the diaphragm (white arrowheads). (f) A microscopic image of the BAL fluid shows a pink microcalcified particle (red arrowhead) interspersed with bronchial mucosal cells (purple).
case_images: JCIS-13-32-g001.jpg
case_images: PMC10629246_01_JCIS-13-32-g001.jpg
case_images: F1
case_images: In the case of a 4-year-old male patient [Figure 1], 4 months after his birth, the child had pneumonia. There was irregular thickening of interstitial tissues and calcification in the interlobular and interloblastic fissures, predominantly in the periphery and lower parts, which was consistent with the typical image of PAM [Figures 1-4]. In addition, in the 4-year-old male patient [Figure 1], wall thickening and narrowing of the bronchial branches (including both lobar and segmental bronchi) were found, and diffuse reticular thickening around the bronchioles was observed in both lungs.
case_images: Chest X-ray, computed tomography (CT), and microscopic images of the bronchoalveolar lavage (BAL) fluid of a 35-year-old male patient who was diagnosed with pulmonary alveolar microlithiasis (PAM). (a-e) The chest X-ray and CT images show many small opacities measuring 1-2 mm in diameter, with diffused interstitial thickening throughout both lung fields, predominately in the lower and posterior regions, forming a "sandstorm" image; calcifications along the blood vessels (a yellow arrowhead) and peripheral regions with air spaces just below the pleura (subpleural sparing) (black ^ shapes). Calcification of the interlobular fissure and pleura adjacent to the diaphragm (white arrowheads) produced sharp contours. (f) A microscopic image of BAL fluid showing pink microcalcified particles (red arrowheads) intermingled with bronchial mucosal cells (dark blue), confirming PAM.
case_images: JCIS-13-32-g002.jpg
case_images: PMC10629246_01_JCIS-13-32-g002.jpg
case_images: F2
case_images: The remaining three patients were adults, including a 35-year-old male patient [Figure 2] who works as a mason and often uses coal for cooking. There was irregular thickening of interstitial tissues and calcification in the interlobular and interloblastic fissures, predominantly in the periphery and lower parts, which was consistent with the typical image of PAM [Figures 1-4]. In the 35-year-old male patient [Figure 2], in addition to the abovementioned CT findings, calcification of the interlobular fissure and pleura adjacent to the diaphragm produced sharp contours with air spaces just below the pleura (subpleural sparing); calcifications along the blood vessels and peripheral regions were also seen; there was a "sandstorm" image in the posterior basal segment on both sides.
case_images: Chest X-ray, computed tomography (CT), and microscopic images of bronchoalveolar lavage (BAL) fluid on a 53-year-old female patient diagnosed with pulmonary alveolar microlithiasis (PAM). (a-e) The chest X-ray and CT images show many large calcified opacities (1-3 mm), spreading throughout both lung fields, predominantly in the periphery (pleura and mediastinum) forming a line with a clear border; reticular interstitial thickening with air spaces just below the pleura and small-balloon alveolar dilatation near the periphery of the lung (black ^ shapes). There is no "sandstorm" sign. (f) A microscopic image of the BAL fluid showing pink microcalcified particles (red arrowheads) intermingled with bronchial mucosal cells (purple), confirming PAM.
case_images: JCIS-13-32-g003.jpg
case_images: PMC10629246_01_JCIS-13-32-g003.jpg
case_images: F3
case_images: The patients in the remaining two cases [Figures 3 and 4] had cough, shortness of breath, chest pain, fatigue, and slight weight loss at the time of admission (approximately 1 kg/month). There was irregular thickening of interstitial tissues and calcification in the interlobular and interloblastic fissures, predominantly in the periphery and lower parts, which was consistent with the typical image of PAM [Figures 1-4]. In the 53-year-old female patient [Figure 3], reticular interstitial thickening was shown to be accompanied by large calcified nodules (1-3 mm), with air spaces just below the pleura and small-balloon alveolar dilatation near the periphery of the lung.
case_images: Chest X-ray, computed tomography (CT), and microscopic images of bronchoalveolar lavage (BAL) fluid in a 19-year-old female patient diagnosed with pulmonary alveolar microlithiasis (PAM). (a-c) The chest X-ray and CT images show many densely calcified nodules, clustering in the periphery and lower part, sticking together to create the "stone lung" image, accompanied by severe pleural calcification adjacent to the diaphragm and the interlobular fissure and pericardial calcification (white arrowheads), looking like an eggshell enclosing the lung parenchyma. (d) A microscopic image of the BAL fluid showing pink microcalcified particles (red arrowheads) intermingled with bronchial mucosal cells (purple), confirming PAM.
case_images: JCIS-13-32-g004.jpg
case_images: PMC10629246_01_JCIS-13-32-g004.jpg
case_images: F4
case_images: The patients in the remaining two cases [Figures 3 and 4] had cough, shortness of breath, chest pain, fatigue, and slight weight loss at the time of admission (approximately 1 kg/month). There was irregular thickening of interstitial tissues and calcification in the interlobular and interloblastic fissures, predominantly in the periphery and lower parts, which was consistent with the typical image of PAM [Figures 1-4]. In the 19-year-old female patient [Figure 4], densely calcified nodules were found, clustering in the periphery and lower part, sticking together to create the "stone lungs" image, accompanied by severe pleural calcification, which looked like an eggshell enclosing the lung parenchyma.