Pulmonary alveolar microlithiasis with minimal symptoms and near-complete whiteout on chest imaging

Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic disease characterized by accumulated calcium and phosphate crystals within the alveoli. Although PAM can be suspected in patients with clinical-radiological dissociation and characteristic imaging findings on chest computed tomography, definitive diagnosis requires a family history of PAM, identification of <i>SLC34A2</i> gene mutations, or lung biopsy to exclude differential diagnoses. We report a case of a 66-year-old female incidentally found to have diffuse pulmonary calcifications. The diagnosis was confirmed through typical imaging features, transbronchial lung biopsy, and a family history of PAM. This case highlights the hallmark imaging characteristics of PAM and the critical role of transbronchial lung biopsy in establishing a definitive diagnosis. As PAM is a rare disease with no established consensus on treatment, except for lung transplantation, symptomatic management remains a significant challenge.