Bone scintigraphy showing intense bilateral uptake of technetium-99m methylene diphosphonate in the lungs. Increased uptake was predominantly located in the lower lung regions 

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Context 1

... 65-year-old man presented with a history of nonspecific chest pain, shortness of breath, wheezing, and a cough ongoing for 4 years. He had substernal burning in the chest that increased with breathing and he reported per- sistent chest pain on the right chest wall and that his cough increased in the presence of dust. He also com- plained of fatigue and headache. He had a 25-pack-year smoking history, but he had quit 35 years earlier. He had been suffering from gastric symptoms compatible with gastroesophageal reflux for 25 years, and hypertension for 10 years. As a result of changes on his chest X-ray and thorax computed tomography (CT) images, a lung biopsy had been recommended 10 years ago, but he had declined because of a lack of symptoms at the time. There was no known family history of respiratory diseases. A physical examination revealed normal vital signs with a pulse rate of 76/minute, blood pressure of 135/78 mmHg, and saturation of 96%. There was no sign of dyspnea, cyanosis, edema, or clubbing. A physical exam- ination of the chest was normal, with the exception of minimal crackles in both basal lungs and a wheeze on forced expiration. Blood test findings, including serum calcium concentration, were normal. Pulmonary function tests demonstrated normal findings with forced expiratory volume in the first second (FEV1) was 2.36 (81.2%) liters, the forced vital capacity (FVC) was 3.09 (82.7%), and the ratio of FEV1/FVC was 76.4%. A reversibility test was negative. There was fine reticular and nodular infiltration observed on a chest X-ray, with numerous fine calcifications dis- persed to the middle and lower lung zones (Figure 1). The findings were more pronounced in the central areas obscuring the mediastinal borders, but the diaphragmatic outlines were protected. A chest CT and high resolution computed tomography (HRCT) revealed bilateral, diffuse, randomly distributed, fine, calcified, interstitial nodules and nodular septal thickening in the middle and lower lung zones (Figure 2). Together with the diffuse but centrally located ground- glass attenuations, the typical crazy paving pattern was apparent in the mid to lower lung zones. The nodules became more intense in the subpleural areas, close to the diffusely calcified pleural surfaces. Whole body bone scintigraphy was performed after intra- venous administration of 20 mCi (740 MBq) technetium- 99m methylene diphosphonate (Tc-99m MDP). The bone scan revealed diffusely increased Tc-99m MDP uptake in both lungs. In accordance with radiological imaging www.respircase.com methods, radiotracer uptake was concentrated at the base of the lungs on bone scintigraphy (Figure 3). The patient was diagnosed with pulmonary alveolar mi- crolithiasis (PAM) according to radiological and radionu- clide imaging. Because the patient did not agree to an invasive procedure, bronchoscopic examination for histo- pathological evaluation could not be performed. ...

Context 2

... 65-year-old man presented with a history of nonspecific chest pain, shortness of breath, wheezing, and a cough ongoing for 4 years. He had substernal burning in the chest that increased with breathing and he reported per- sistent chest pain on the right chest wall and that his cough increased in the presence of dust. He also com- plained of fatigue and headache. He had a 25-pack-year smoking history, but he had quit 35 years earlier. He had been suffering from gastric symptoms compatible with gastroesophageal reflux for 25 years, and hypertension for 10 years. As a result of changes on his chest X-ray and thorax computed tomography (CT) images, a lung biopsy had been recommended 10 years ago, but he had declined because of a lack of symptoms at the time. There was no known family history of respiratory diseases. A physical examination revealed normal vital signs with a pulse rate of 76/minute, blood pressure of 135/78 mmHg, and saturation of 96%. There was no sign of dyspnea, cyanosis, edema, or clubbing. A physical exam- ination of the chest was normal, with the exception of minimal crackles in both basal lungs and a wheeze on forced expiration. Blood test findings, including serum calcium concentration, were normal. Pulmonary function tests demonstrated normal findings with forced expiratory volume in the first second (FEV1) was 2.36 (81.2%) liters, the forced vital capacity (FVC) was 3.09 (82.7%), and the ratio of FEV1/FVC was 76.4%. A reversibility test was negative. There was fine reticular and nodular infiltration observed on a chest X-ray, with numerous fine calcifications dis- persed to the middle and lower lung zones (Figure 1). The findings were more pronounced in the central areas obscuring the mediastinal borders, but the diaphragmatic outlines were protected. A chest CT and high resolution computed tomography (HRCT) revealed bilateral, diffuse, randomly distributed, fine, calcified, interstitial nodules and nodular septal thickening in the middle and lower lung zones (Figure 2). Together with the diffuse but centrally located ground- glass attenuations, the typical crazy paving pattern was apparent in the mid to lower lung zones. The nodules became more intense in the subpleural areas, close to the diffusely calcified pleural surfaces. Whole body bone scintigraphy was performed after intra- venous administration of 20 mCi (740 MBq) technetium- 99m methylene diphosphonate (Tc-99m MDP). The bone scan revealed diffusely increased Tc-99m MDP uptake in both lungs. In accordance with radiological imaging www.respircase.com methods, radiotracer uptake was concentrated at the base of the lungs on bone scintigraphy (Figure 3). The patient was diagnosed with pulmonary alveolar mi- crolithiasis (PAM) according to radiological and radionu- clide imaging. Because the patient did not agree to an invasive procedure, bronchoscopic examination for histo- pathological evaluation could not be performed. ...

Context 3

... 65-year-old man presented with a history of nonspecific chest pain, shortness of breath, wheezing, and a cough ongoing for 4 years. He had substernal burning in the chest that increased with breathing and he reported per- sistent chest pain on the right chest wall and that his cough increased in the presence of dust. He also com- plained of fatigue and headache. He had a 25-pack-year smoking history, but he had quit 35 years earlier. He had been suffering from gastric symptoms compatible with gastroesophageal reflux for 25 years, and hypertension for 10 years. As a result of changes on his chest X-ray and thorax computed tomography (CT) images, a lung biopsy had been recommended 10 years ago, but he had declined because of a lack of symptoms at the time. There was no known family history of respiratory diseases. A physical examination revealed normal vital signs with a pulse rate of 76/minute, blood pressure of 135/78 mmHg, and saturation of 96%. There was no sign of dyspnea, cyanosis, edema, or clubbing. A physical exam- ination of the chest was normal, with the exception of minimal crackles in both basal lungs and a wheeze on forced expiration. Blood test findings, including serum calcium concentration, were normal. Pulmonary function tests demonstrated normal findings with forced expiratory volume in the first second (FEV1) was 2.36 (81.2%) liters, the forced vital capacity (FVC) was 3.09 (82.7%), and the ratio of FEV1/FVC was 76.4%. A reversibility test was negative. There was fine reticular and nodular infiltration observed on a chest X-ray, with numerous fine calcifications dis- persed to the middle and lower lung zones (Figure 1). The findings were more pronounced in the central areas obscuring the mediastinal borders, but the diaphragmatic outlines were protected. A chest CT and high resolution computed tomography (HRCT) revealed bilateral, diffuse, randomly distributed, fine, calcified, interstitial nodules and nodular septal thickening in the middle and lower lung zones (Figure 2). Together with the diffuse but centrally located ground- glass attenuations, the typical crazy paving pattern was apparent in the mid to lower lung zones. The nodules became more intense in the subpleural areas, close to the diffusely calcified pleural surfaces. Whole body bone scintigraphy was performed after intra- venous administration of 20 mCi (740 MBq) technetium- 99m methylene diphosphonate (Tc-99m MDP). The bone scan revealed diffusely increased Tc-99m MDP uptake in both lungs. In accordance with radiological imaging www.respircase.com methods, radiotracer uptake was concentrated at the base of the lungs on bone scintigraphy (Figure 3). The patient was diagnosed with pulmonary alveolar mi- crolithiasis (PAM) according to radiological and radionu- clide imaging. Because the patient did not agree to an invasive procedure, bronchoscopic examination for histo- pathological evaluation could not be performed. ...