24043987 Visualization

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