SESSION TITLE: Lung Pathology Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Tuesday, October 27, 2015 at 04:30 PM - 05:30 PM
INTRODUCTION: Pulmonary calcification is the deposition of calcium in a normal pulmonary parenchyma.It is commonly due to chronic renal failure, hypercalcemia and increased tissue alkalinity(1).Deposition of calcium in the interstitium commonly seen in high resolution Computed tomography (CT) up to 60%, but rarely seen on radiographic images(2).
CASE PRESENTATION: A 46 year old male patient who presented with acute flank pain for which CT showed a 2 mm calculus in the left ureter showed incidental nodular densities in the lung bases, some appearing calcified. Patient had repeat chest CT showing diffuse calcified and non calcified micronodules throughout the lung parenchyma bilaterally. His pulmonary functiontest(PFT) and TB Quantiferon gold were normal, but CRP and ESR were elevated. At this point, patient preferred surveillance. Patient has been asymptomatic clinically. After 7 months, a repeat chest CT revealed progression of innumerable calcified and non calcified military nodules throughout both lungs(Image 1). Patient denied constitutional symptoms and no exposure to inhalation of dust including fiberglass, plastic, paper and paint. A PET/CT demonstrated a hazy mild hypermetabolic activity in the lungs corresponding to the military nodules. Right Video assisted thoracoscopy performed and wedge resection of lower lobe done. The histologic evaluation reveals nodular masses of bone that are located predominantly within alveolar spaces Image 2). Patient remains asymptomatic and doing well after surgery.
DISCUSSION: Diffuse pulmonary calcinosis commonly occur in hypercalcemia state more commonly related to renal failure than primary hyperparathyroidism, skeletal metastasis or multiple myeloma (1). In asymptomatic patients, the PFT is normal as in our patient. However, restrictive pattern with decreased diffusion capacity, hypoxemia and chronic respiratory failure may be noted. Lung transplant is the only option of treatment, if the disease progress with symptoms.
CONCLUSIONS: Rarely, Pulmonary calcinosis can happen with normal renal function and normal calcium levels.
Reference #1: Bendayan D,Barziv Y, Kramer MR. Pulmonary calcifications: A review. Resp Med. 2000;94;190-193
Reference #2: Hartman TE, Muller NL, Primack SL, et al. Metastatic pulmonary calcification in patients with hypercalcemia: findings on chest radiographs and CT scans. AJR Am J Roentgenol. 1994;162:799-802
Reference #3: Unusual manifestations of Metastatic pulmonary calcification: high resolution CT and pathological findings. J Thoracic Imaging. 2005; 20:66-70
DISCLOSURE: The following authors have nothing to disclose: Nebiyu Biru, Mouhammed Rihawi
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