--- a
+++ b/processing/MACCROBAT/24043987.txt
@@ -0,0 +1,23 @@
+A 24-year-old Malay male patient was referred to the respiratory clinic because of an abnormal pre-employment chest radiograph.
+He had been smoking about 10 cigarettes a day since he was 21 years of age.
+He stopped smoking 10 months ago after he noticed he had being having reduced effort tolerance for the past three years.
+He was an office worker and did not have a history of exposure to organic or inorganic dusts.
+His two siblings were asymptomatic.
+On examination, the patient was not tachypnoeic.
+There were no signs of finger clubbing or pulmonary hypertension.
+His oxygen saturation on room air at rest was 94% and dropped to 92% after climbing up four flights of stairs.
+Spirometry testing revealed a restrictive pattern of lung disease with a forced expiratory volume in 1 second (FEV1) and a forced vital capacity (FVC) of 2.7 L (69% of predicted) and 3.2 L (68% of predicted), respectively.
+The FEV1/FVC ratio was 85%.
+His haemoglobin (168 g/L), serum parathyroid hormone (2.9 pmol/L [normal, 1.1-7.3]) and calcium (2.34 mmol/L) levels were normal.
+24-hour urine calcium was also normal 6.9 mmol with a 24-hour urine volume of 2.8 L.
+His chest radiograph (Fig.1A) revealed dense micronodular opacities distributed symmetrically and predominantly in the middle to lower zones of both lungs giving the classical "sandstorm" appearance.
+The cardiac borders were obscured by the sand-like opacities.
+A high-resolution computed tomography (HRCT) scan of the lungs (Fig.1B) showed widespread tiny microcalcifications throughout the lungs with a preponderance of microliths in the lower lobes.
+There were associated areas of interlobular septal thickening and ground-glass changes.
+Subpleural cystic changes were also seen in both lower lobes giving rise to the 'black pleura sign' (Fig.1C) (2).
+No pneumothorax or pleural effusion was present.
+Both the bronchial system (including the small bronchioles) and the size of the pulmonary vessels were normal.
+As this was diffuse parenchymal lung disease, videoassisted thoracic surgical (VATS) lung biopsy was planned but the procedure was converted into a mini-thoracotomy because there was difficulty in manoeuvering the endostapler.
+There was a moderate pneumothorax postmini-thoracotomy from which the patient fully recovered after 5 days in the ward.
+The lung biopsy specimen revealed features consistent with PAM, with numerous calcospherites within the alveolar spaces (Fig.1D).
+The intervening alveolar septae were congested and showed mild fibrosis with infiltrates of mainly lymphoplasmacytic cells.