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Pulmonary alveolar microlithiasis (PAM) is a rare inherited pulmonary disease characterized by the deposition of intra-alveolar calcium deposits. In most of the Asian and European countries, PAM is usually misdiagnosed as pulmonary tuberculosis and sarcoidosis. We presented a young case of PAM manifested as chronic progressive dyspnea unresponsive to corticosteroids for one year. The first diagnostic clues were made by high resolution computed tomography. Although Bronchoalveolar lavage and transbronchial lung biopsy examination were unremarkable, however, after performing a Video-assisted thoracoscopic surgery, the biopsy specimens confirmed the diagnosis of PAM.