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      Atypical Radiological Manifestation of Pulmonary Metastatic Calcification

      case-report

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          Abstract

          Metastatic pulmonary calcification refers to calcium deposition in the normal pulmonary parenchyma and this deposition is secondary to abnormal calcium metabolism. The most common radiologic manifestation consists of poorly-defined nodular opacities that are mainly seen in the upper lung zone. We present here a case of metastatic pulmonary calcification that manifested as atypical, dense, calcium deposition in airspaces within the previously existing consolidation in the bilateral lower lobes, and this process was accelerated by pneumoniacomplicated sepsis in a patient with hypercalcemia that was due to hyperparathyroidism.

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          Calcium deposition with or without bone formation in the lung.

          Eward D. Chan, Alan Welsh, Esther I. Schwarz … (2002)
          Pulmonary calcification and ossification occurs with a number of systemic and pulmonary conditions. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. Pathophysiologic states predisposing to pulmonary calcification and ossification include hypercalcemia, a local alkaline environment, and previous lung injury. Factors such as enhanced alkaline phosphatase activity, active angiogenesis, and mitogenic effects of growth factors may also contribute. The clinical classification of pulmonary calcification includes both metastatic calcification, in which calcium deposits in previously normal lung or dystrophic calcification, which occurs in previously injured lung. Pulmonary ossification can be idiopathic or can result from a variety of underlying pulmonary, cardiac, or extracardiopulmonary disorders. The diagnosis of pulmonary calcification and ossification requires various imaging techniques, including chest radiography, computed tomographic scanning, and bone scintigraphy. Interpretation of the presence of and the specific pattern of calcification or ossification may obviate the need for invasive biopsy. In this review, specific conditions causing pulmonary calcification or ossification that may impact diagnostic and treatment decisions are highlighted. These include metastatic calcification caused by chronic renal failure and orthotopic liver transplantation, dystrophic calcification caused by granulomatous disorders, DNA viruses, parasitic infections, pulmonary amyloidosis, vascular calcification, the idiopathic disorder pulmonary alveolar microlithiasis, and various forms of pulmonary ossification.
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            Pulmonary calcifications: a review.

            Jamie Kramer, Y Barziv, D Bendayan (2000)
            Pulmonary calcification is a common asymptomatic finding, usually discovered on routine chest X-ray or at autopsy. Pulmonary calcifications are caused mainly by two mechanisms: the dystrophic form and the metastatic form (1). Despite the different aetiologies, the pulmonary function and clinical manifestations are quite similar in both forms. We present a review of the clinical and radiology findings of the different aspects of pulmonary calcifications according to its pathogenesis and its anatomic distribution: parenchymal, lymphe node and pleural.
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              Metabolic lung disease: imaging and histopathologic findings.

              Tomas Franquet, Emma Chung, Joungho Han … (2005)
              Metabolic lung disease includes pulmonary alveolar proteinosis (PAP), pulmonary amyloidosis, metastatic pulmonary calcification, dendritic pulmonary ossification, pulmonary alveolar microlithiasis, and storage diseases. In pulmonary alveolar proteinosis, CT demonstrates air-space consolidation with thickened interlobular septa, producing the so-called "crazy paving" appearance. Pulmonary amyloidosis can appear as parenchymal nodules (nodular parenchymal form), diffuse interstitial deposit (diffuse interstitial form), or submucosal deposits in the airways (tracheobronchial form). Metastatic pulmonary calcification may appear on high-resolution CT as numerous 3- to 10-mm diameter calcified nodules or, more commonly as fluffy and poorly defined nodular opacities. In pulmonary microlithiasis, high-resolution CT demonstrates diffuse punctuate micronodules showing slight perilobular predominance resulting in apparent calcification of interlobular septa. Niemann-Pick disease appears as ground-glass attenuation in the upper lung zone and thickening of the interlobular septa in the lower lung zone. Radiologic study including high-resolution CT will be helpful for the diagnosis and follow-up of these diseases.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Radiol
                Journal ID (publisher-id): KJR
                Title: Korean Journal of Radiology
                Publisher: The Korean Radiological Society
                ISSN (Print): 1229-6929
                ISSN (Electronic): 2005-8330
                Publication date (Print): Mar-Apr 2008
                Publication date (Electronic): 20 April 2008
                Volume: 9
                Issue: 2
                Pages: 186-189
                Affiliations
                [1 ]Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Korea.
                [2 ]Department of Pathology, Korea University College of Medicine, Seoul 136-705, Korea.
                [3 ]Department of Diagnostic Radiology, Korea University College of Medicine, Seoul 136-705, Korea.
                Author notes
                Address reprint requests to: Eun Hae Kang, MD, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, 126-1, 5-ka, Anam-dong, Sungbuk-ku, Seoul 136-705, Korea. Tel. (822) 920-6611, Fax. (822) 929-2045, keunhae@ 123456unitel.co.kr
                Article
                DOI: 10.3348/kjr.2008.9.2.186
                PMC ID: 2627227
                PubMed ID: 18385568
                SO-VID: c1ca8e73-27fc-4356-ae21-26e15140086c
                Copyright © Copyright © 2008 The Korean Radiological Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 October 2007
                Date accepted : 11 December 2007
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: hyperparathyroidism,lung, metastatic calcification
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: hyperparathyroidism, lung, metastatic calcification

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