HomeRadiologyVol. 73, No. 5 PreviousNext Announcements and Book ReviewsLetters to the EditorTo the Editor of RadiologyPublished Online:Nov 1 1959https://doi.org/10.1148/73.5.790cMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDear Dr. Doub:I was interested to see the report of further cases of pulmonary alveolar microlithiasis by Dr. Gon-zalo Esguerra Gómez and his colleagues in the April 1959 issue of Radiology. It is likely that this rare condition will be increasingly reported as it is more widely recognized, because the x-ray appearances, once seen, are unmistakable, especially when taken in conjunction with the clinical history, and often supported by a familial occurrence.I do not believe that pleural thickening is a characteristic feature of this condition as suggested in the above paper, although, of course, it can result from the physiological breakdown that eventually overtakes the lungs and heart, or from any chance concurrent infection. The white lines of the interlobar fissures and overall lung surfaces are subpleural and due to concentration of the calcospherites. This was well seen in many of the cases reported by the late Dr. Sosman and his colleagues (Am. J. Roentgenol. 77: 947, 1957), and in my own reported case (J. Fac. Radiologists 10: 54, 1959); it is well demonstrated in Gough's paper-mounted section reproduced by Sosman, and must be considered a characteristic feature of the disease. At the interlobar surfaces the line will be seen more clearly because two adjacent lung surfaces and their subpleural concentration of calculi are contributing to the shadow.Yours sincerely,W. R. COLE, M.B., D.M.R.D.Fremantle, PerthWestern AustraliaDr. Esguerra Gómez has replied to the above letter of Dr. Cole, as follows:To the Editor of RadiologyDear Dr. Doub:I am entirely in agreement with Dr. W. R. Cole that the radiological aspect of thickening of the lesser interlobar fissure cannot be considered a pathognomonic sign of pulmonary alveolar microlithiasis. For this reason alone we have pointed out the fact that, in our three cases in which the lesions had not completely obscured the lower half of the pulmonary fields, there was appreciably a radiologic aspect of thickening of the fissures.Evidently, in our Case I (Case No. 3 of Dr. Sosman), and in other published observations as described by Dr. Sosman, “the minor interlobar fissure was definitely thickened and dense, probably due to heavy deposits of calcium salts.” But in our other 2 cases, and in some of the published examples, the shadow is exclusively that of fissurai thickening and one is unable to declare that there is “subpleural concentration of calculi.” In the paper-mounted section of Gough, to which Dr. Cole refers, one does not see fissurai thickening but accentuation of deposits (microliths) along the interlobar fissure. A corresponding roentgenogram made on the living patient is not reproduced.Article HistoryPublished in print: Nov 1959 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 73, No. 5 Metrics Altmetric Score PDF download