대한흉부영상의학회 Weekly Chest Cases

Case No : 1225 Date 2021-04-12

Courtesy of Suji Lee / Severance Hospital, Yonsei University College of Medicine
Age/Sex 44 / M
Chief ComplaintESRD on HD, HTN, DM, CAD s/p PTCA

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Diagnosis With Brief Discussion

Diagnosis: Metastatic Pulmonary Calcification
Radiologic Findings: Fig. 1. Chest posteroanterior radiograph showing multifocal patchy ground-glass opacities (GGOs) in both lungs and suspicious linear calcification in the right upper lung zone.
Figs. 2–5. Computed tomography scans revealing multifocal GGOs and centrilobular nodules with or without dense calcification in both lungs.
Brief Review: Metastatic pulmonary calcification (MPC) is a subdiagnosed metabolic lung disease that is commonly associated with end-stage renal disease. This interstitial process is characterized by the deposition of calcium salts, predominantly in the alveolar epithelial basement membrane. MPC is seen at autopsy in 60%–75% of patients with renal failure. It is often asymptomatic but can potentially progress to respiratory failure. Clinically, the degree of respiratory distress is often not correlated with the degree of macroscopic calcification. Although the factors involved in the development of the more aggressive form of MPC are not fully understood, accelerated progression of the condition after failed renal transplantation or hypercalcemia has been previously reported.
The findings of plain film radiography are nonspecific and not very useful for the diagnosis of MPC. Chest radiographs frequently show normal findings or demonstrate confluent or patchy airspace opacities. MPC can also appear as discrete or confluent calcified nodules or as a diffuse interstitial process. The relative stability of these pulmonary infiltrates, in contrast to infectious processes, and their resistance to treatment have diagnostic value. The density of opacities is not sufficiently high to suggest calcification in most reported cases, whereas the opacities are massively calcified or become progressively denser when left untreated in some cases.
Computed tomography (CT) is much more sensitive than chest radiography for detecting small amounts of calcification. Changes visible on CT are most marked in the upper zones of the lungs owing to increased alkalinity at the apices, which is conducive to the deposition of calcium salts. Although the infiltrates are histologically interstitial in nature, MPC can mimic airspace disease on CT. The most common parenchymal finding on high-resolution CT is the presence of centrilobular ground-glass nodular opacities, with numerous fluffy and poorly defined nodules 3–10 mm in diameter. These opacities may or may not contain calcification foci. A frequently associated finding is calcification in the vessels of the chest wall. The combination of pulmonary and vascular calcification is considered to be of diagnostic value for MPC.
Please refer to: KSTR imaging conference 2017 Spring Case 15,
References: 1. Belém LC, Zanetti G, Souza Jr AS, Hochhegger B, Guimaraes MD, Nobre LF, Rodrigues RS, Marchiori E. Metastatic pulmonary calcification: state-of-the-art review focused on imaging findings. Respiratory medicine 2014;108(5):668-676.
Keywords

No. of Applicants : 93

▶ Correct Answer : 38/93, 40.9%

- , Japan KEI SASAKI
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa General Hospital , Japan MASAFUMI KAIUME
- Ajou University School of Medicine , Korea (South) JUNG YONG JUN
- Chungbuk National University Hospital , Korea (South) HOSIG JANG
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
- Chungbuk National University Hospital , Korea (South) JIYUN KANG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Ajou University Hospital , Korea (South) KYUNGMIN LEE
- Other , Korea (South) SEONGSU KANG
- Ajou University Hospital , Korea (South) HAEIN LEE
- Ajou University Hospital , Korea (South) SEUNGJIN HAN
- , Korea (South) HYEWON CHOI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- HHS , Canada S LEE
- Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
- Yeungnam University Medical Center , Korea (South) JONGSOO PARK
- Ajou University Hospital , Korea (South) DAYOUNG KIM
- Kangwon National University Hospital , Korea (South) SEONGJAE BAE
- Osaka City General Hospital , Japan SHU MATSUSHITA
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Other , Korea (South) MINSU KIM
- Chungbuk National University Hospital , Korea (South) CHANSEOP KIM
- , Japan HIROAKI ARAKAWA
- , India PURUSHOTHAMA RAO TUMMALA
- Kyoto University Hospital , Japan SATOSHI IKEDA
- Nishida Hospital , Japan SHOJI OKUDA
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan KAZUMA TERAUCHI
- Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Hanyang University Hospital , Korea (South) SEUNG JIN YOO

▶ Correct Answer as Differential Diagnosis : 15/93, 16.1%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan HIROAKI ARAKAWA
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- , Italy PAOLO BALDASSARI
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- Gifu University Hospital , Japan Yo Kaneko
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- TB centre kasaragod. , India rikhy krishnan
- Chonbuk National University Hospital , Korea (South) MINJEE KIM
- Toranomon Hospital , Japan KAORU SUMIDA
- Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
- Private sector , Greece VASILIOS TZILAS
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 1/93, 1.1%

- NIMS, HYDERABAD , India BHASKAR K

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1225 Date 2021-04-12

Discussion

No. of Applicants : 93