Typical imaging findings demonstrate a "sandstorm" appearance due to bilateral, interstitial sand-like micronodularities with basal predominance.<h4>Methods and results</h4>We describe an unusual case of a 48-year-old male with severe, familial PAM ultimately treated with a bilateral lung transplant.<h4>Conclusions</h4>PAM is a rare lung disease caused by a mutation in the <i>SLC34A2</i> gene, which encodes for a sodium-phosphate cotransporter in type II alveolar cells, leading to accumulation of intra-alveolar phosphate causing microlith formation. The gene discussed is SLC34A2; the disease is lung disorder.