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Pulmonary alveolar microlithiasis presenting with crazy-paving pattern on high resolution CT

Departments of ¹ Diagnostic Radiology, ² Internal Medicine and ³ Pathology, University of Paraná School of Medicine, Curitiba, PR, Brazil

Correspondence: Emerson L Gasparetto, Serviço de Radiologia Médica, Hospital de Clínicas da UFPR, Av General Carneiro 181, CEP: 80060900, Curitiba, Paraná, Brazil

Pulmonary alveolar microlithiasis (PAM) is an uncommon chronic disease characterized by calcifications within the alveoli and a paucity of symptoms in contrast to the imaging findings. We present a 59-year-old woman with a 4-year history of shortness of breath on exertion. Lung auscultation revealed random wheezes and fine and coarse crackles. Pulmonary function tests showed a restrictive pattern. The chest radiograph demonstrated a bilateral symmetric micronodular pattern. High resolution CT scan revealed diffuse ground-glass attenuation with superimposed septal thickening ("crazy-paving" pattern). The patient underwent a lung biopsy, which confirmed the diagnosis of PAM. Our case demonstrates that PAM needs to be considerate in the differential diagnosis of lung lesions that present with crazy-paving pattern on the high resolution CT.