PT - JOURNAL ARTICLE AU - Henrik Wurps AU - Sergej Griff AU - Michael Knappik AU - Nicolas Schönfeld AU - Torsten T. Bauer AU - Thomas Mairinger AU - Wolfram Grüning TI - Pulmonary-alveolar microlithiasis (PAM) as a rare diffential diagnosis of diffuse lung diseases diagnosed by transbronchial cryobiopsy DP - 2012 Sep 01 TA - European Respiratory Journal PG - P3583 VI - 40 IP - Suppl 56 4099 - http://erj.ersjournals.com/content/40/Suppl_56/P3583.short 4100 - http://erj.ersjournals.com/content/40/Suppl_56/P3583.full SO - Eur Respir J2012 Sep 01; 40 AB - Introduction: PAM is a rare pulmonal disease of unknown origin. Microscopically, it is characterized by diffuse alveolar calcification. Chest x-ray usually presents a „sandstorm“ image. Diffuse lung diseases are typically diagnosed by computed tomographic imaging; histological validation is won by surgical lung biopsy. Current studies show a more important role of transbronchial cryobiopsy for histological diagnosis.Case Report: A 26-year-old male presented with dyspnea. The radiographic images (chest x-ray, computed tomography) showed interstitial pulmonal changes without PAM-typical signs. Blood gas analysis, blood test results and pulmonal function did not show abnormities. For further evaluation we performed bronchoscopy with transbronchial cryo- and forcepsbiopsy.Methods: Cryoprobe and forceps were introduced into the left lower lobe under radiological guidance; the cryoprobe was cooled for five seconds and then retracted with the frozen lung tissue. The specimen were rated by two experienced lung pathologists.Results: Histologically the forcepsbiopsy showed only few hints for PAM, whereas in the cryobiopsy a pulmonal-alveolar microlithiasis could be proven due to big amount of alveolar tissue with concentric calcification. In respect to untypical radiographic signs this was determining.Conclusion: There is a huge variety of diffuse lung diseases. The diagnosis of PAM was surprising because the radiographic images showed an untypical morphology. The histological diagnosis of PAM was proven by transbronchial cryobiopsy. This shows the potential impact of transbronchial cryobiopsy in different entities of interstitial lung disease.