1. Mental Status Changes

2. History 52 y o female presented to the ED with mental status changes Bradycardia noted in ED

3. Chest Radiograph

4. Chest CT

5. History Lifelong nonsmoker Maternal history of emphysema ◦ Smoker Chronic daily cough No hemoptysis SOB with exertion No toxic exposure

6. Lymphangioleiomyomatosis (LAM) Proliferation of pulmonary interstitial smooth muscle and cyst formation ◦ Infiltration into lung parenchyma, lymphatics, airways and blood vessels Lungs are large and diffusely cystic Often misdiagnosed as asthma or COPD Most common presenting symptoms: ◦ Dyspnea ◦ Pneumothorax Gross specimen demonstrating cystic changes

7. Lymphangioleiomyomatosis (LAM) Progressive disease, no treatment is curative Median survival is 8-10 years from time of diagnosis Female predominance ◦ Usually occurs during the reproductive years Pregnancy and HRT accelerate the disease