A case of pulmonary alveolar microlithiasis showing respiratory failure after 33 years and revealing microliths in bronchoalveolar lavage

Abstract

A 43-year-old woman was admitted to our hospital because of dyspnea and anorexia. She had hypoxia and cyanosis. The chest roentgenogram revealed dense reticular, partly nodular shadow and emphysematous bullae in both lung fields. An abnormal chest X-ray had been pointed out and pulmonary alveolar microlithiasis had been diagnosed 33 years previously. Bronchoscopy and bronchoalveolar lavage were performed and calcium microliths were seen in the bronchoalveolar lavage fluid smear. Bronchoalveolar lavage appears useful in the diagnosis of pulmonary alveolar microlithiasis. A series of X-ray findings showed development of emphysematous bullae, niveau formation and disappearance of bullae. These changes seem to reveal the progress of her disease from the established stage to the advanced stage. Such a case of pulmonary alveolar microlithiasis over the course of a long period is rare.