19-years old boy with gradually progressive breathlessness. Pulmonary alveolar microlithiasis (PAM) is one of those rare situations, where the radiograph is a spot diagnosis compared to the CT scan. The CT scans show the “black pleura” sign along with subtle subpleural and peri-lymphatic calcification / ossification. The soft tissue windows show the calcification / ossification better. Septal thickening in the lower lobes is a common manifestation.

#alveolarmicrolithiasis #blackpleura