PMC8041554_01
Radiologic findings consistent with PAM. (a) Chest X-ray demonstrating diffuse bilateral interstitial hyperdensities with bibasilar predominance consistent with severe interstitial lung disease. (b) Transverse view of chest CT showing diffuse ground-glass opacities, peripheral cystic change, and diffuse areas of fine calcification.
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fig1
Chest X-ray demonstrated the classic "sandstorm" appearance of severe bilateral interstitial hyperdensities with a basilar predominance (Figure 1(a)). A chest CT scan showed chronic interstitial lung disease with diffuse ground-glass opacities, peripheral cystic changes, and numerous areas of calcification (Figure 1(b)).
Histologic examination of explanted lung tissue. (a) 4x H&E sections of bilateral lung parenchyma demonstrated similar findings consisting of numerous microliths filling alveolar spaces, diffuse interstitial fibrosis, and focal osseous metaplasia. (b) 10x higher magnification showing the characteristic concentric calcification of the microliths and focal osseous metaplasia.
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fig2
Multiple foci of osseous metaplasia and chronic inflammation with germinal center formation were identified (Figures 2(a) and 2(b)).