Fiberoptic bronchoscopy was done along with bronchoalveolar lavage, in which microliths were observed. The lavage fluid was not suggestive of tuberculosis or fungi. Transbronchial biopsy was performed, which revealed concentric laminated microliths in the alveoli along with thickened interstitial septa, confirming the diagnosis of PAM. Discussion The incidence of PAM is worldwide; however, approximately one-quarter of the patients are from Turkey – having almost equal male and female sex predilection 4 Mostly, patients affected with this disease are asymptomatic and are diagnosed incidentally on

imaging. Patients check details become symptomatic usually with the advancement of the disease. Non-productive cough Inhibitors,research,lifescience,medical and dyspnea on exertion are the common symptoms; nevertheless, in the later course of the disease – respiratory insufficiency, cor pulmonale, and even death may occur.5 On chest radiograph, numerous sand-like microliths or calcispherites are seen diffusely scattered in bilateral lung fields – Inhibitors,research,lifescience,medical predominantly in the lower two-thirds of the lungs – obscuring the diaphragmatic, mediastinal, and cardiac borders. The propensity of the disease for the lung bases is probably due to the larger volume of the lower lobes. Bullae in the lung apices, a zone of hyperlucency between the lung parenchyma

and the ribs (known as a black pleural line), Inhibitors,research,lifescience,medical and calcification in the pleura could be the other manifestations. The pattern of calcification may be uniform

or may show coarsely linear nodulations. Also, reticulations and septal lines can occasionally be seen on chest radiograph.6 For the evaluation of PAM, HRCT is preferred with thin collimation axial Inhibitors,research,lifescience,medical scans and image reconstruction with a high-resolution algorithm. Minimal morphological changes of the lung parenchyma which are not well evaluated on radiography or with other CT techniques can be detected Inhibitors,research,lifescience,medical by HRCT. HRCT chest reveals intra-alveolar calcifications (microliths), manifesting as micronodular or ground-glass opacities along with superimposed septal thickening – i.e. crazy-paving pattern – predominantly in the postero-basal regions along the bronchovascular bundles and subpleural regions.7 The black pleural lines can be confused due to thin-walled subpleural cysts on HRCT. There Sitaxentan are several diffuse lung diseases with pulmonary calcifications which might be included in the differential diagnosis of PAM such as pulmonary alveolar proteinosis, amyloidosis, metastatic pulmonary calcification, pulmonary vascular diseases, hyperparathyroidism, previous DNA virus infection, and chronic renal failure.8 Although PAM can be easily diagnosed by bronchoalveolar lavage,9 bronchoalveolar lavage and sputum examination for the presence of microliths are non-specific for the diagnosis of PAM in as much as microliths can also be found in patients with tuberculosis and chronic obstructive pulmonary disease.