Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3851-3858
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3851
Single-lung transplantation for pulmonary alveolar microlithiasis: A case report
Xing-Yu Ren, Xiang-Ming Fang, Jing-Yu Chen, Hao Ding, Yan Wang, Qiu Lu, Jia-Lei Ming, Li-Juan Zhou, Hong-Wei Chen
Xing-Yu Ren, Xiang-Ming Fang, Yan Wang, Qiu Lu, Jia-Lei Ming, Li-Juan Zhou, Hong-Wei Chen, Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
Jing-Yu Chen, Hao Ding, Lung Transplantation Center, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
Author contributions: Ren XY and Fang XM analyzed and interpreted the imaging findings, reviewed the literature, and contributed to manuscript drafting; Chen JY and Ding H were the patient’s lung transplantation surgeons; Wang Y and Lu Q collected the relevant data; Ming JL and Zhou LJ reviewed the literature and contributed to manuscript drafting; Chen HW was responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed consent was obtained from the patient included in the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong-Wei Chen, MD, Doctor, Professor, Department of Radiology, Wuxi People's Hospital-Nanjing Medical University, 299 Qingyang Road, Wuxi 214000, Jiangsu Province, China. chw6312@163.com
Telephone: +86-510-86830398
Received: June 16, 2019
Peer-review started: June 21, 2019
First decision: September 9, 2019
Revised: September 24, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: November 26, 2019
Abstract
BACKGROUND

Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths. Currently, effective therapeutics for PAM are not available, and the only treatment for end-stage lung disease is lung transplantation (LuTx). Further, there are few reports that focus on LuTx for the treatment of PAM, and the follow-up reports of postoperative imaging are even rarer.

CASE SUMMARY

A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and exacerbation. The patient was diagnosed with PAM and referred for single-LuTx (SLuTx) on March 14, 2018. Preoperative imaging results from a chest X-ray demonstrated bilateral, diffuse, symmetrical, sandstorm-like radiopaque micronodules, and pneumothorax and a computed tomography scan revealed minute, calcified military nodules in both lungs. We performed a left SLuTx, and intraoperative pathology was consistent with PAM. One week after surgery, a chest X-ray revealed slight exudation of the left lung, and one month later, the left transplanted lung exhibited good dilation, mild pulmonary perfusion injury with local infection, and left pleural effusion. Fiberoptic bronchoscopy revealed left hyperplastic granulation at the left bronchial anastomosis. Multiple sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter baumannii. The last follow-up was conducted in April 2019; the patient recovered well.

CONCLUSION

This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.

Keywords: Pulmonary alveolar microlithiasis, Lung transplantation, Complications, Chest X-ray, Computed tomography, Case report

Core tip: Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths. Currently, there are no effective therapeutic drugs for PAM, and the only treatment for end-stage lung disease is lung transplantation (LuTx). Here we present a rare case of alveolar microlithiasis transplantation. This case highlights the importance of imaging findings of PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of PAM.