There are a number of important considerations for the proposed limited CT scan approach for TSC-LAM screening. First, this strategy is intended only for women with TSC who lack pulmonary symptoms and not for men, for evaluation of possible sporadic LAM, or for subjects with atypical chest radiograph findings, dyspnea, cough, chest pain, pneumothorax, chylothorax, hemoptysis, or chyloptysis. Furthermore, the limited CT scan approach is intended only as an initial screen, and full scanning should be completed for any patient with a positive study. In LAM, thin-walled cysts of varying sizes are distributed throughout the lungs. However, the presence of small numbers of scattered small cysts is not specific to LAM, and it may be more challenging to distinguish early or mild LAM from idiopathic lung cysts, follicular bronchiolitis, centrilobular emphysema, or Langerhans cell histiocytosis, which can have a similar radiographic appearance.14 Availability of the entire CT scan in this study facilitated a confident diagnosis of LAM, based on the typical morphology and distribution of cysts, and, perhaps more importantly, by the ability to better exclude other parenchymal findings that might have suggested alternative diagnoses. Therefore, any future implementation of limited CT scan approaches for LAM should include the recommendation for full chest CT scan on all patients with positive screens, so that the characteristics and distribution of all cysts and the presence of other abnormalities can be used in diagnostic assessment.