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Weekly Chest CasesArchive of Old Cases

Case No : 628 Date 2009-11-08

  • Courtesy of Yoon Kyung Kim, Hwan-Seok Yong, Eun-Young Kang, Ok Hee Woo. / Korea University Guro Hospital, Korea
  • Age/Sex 30 / F
  • Chief ComplaintGenreal weakness, PHx: Chronic renal failure
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Metastsatic pulmonary calcification
Radiologic Findings
Posteroanterior chest radiograph shows ground-glass opacity in both lungs and tumoral calcifications in both acromioclavicular joints. Thin-section CT scans show diffuse ground-glass opacity in both lungs, and calcified consolidations in subpleural areas of lower lungs. On Tc-99m MDP bone scan images, intense uptake is seen in skull, mandible and shoulder joints (Fig 8). Both lungs shows diffuse uptake also. She had hyperparathyroidism and these findings were improved after parathyroidectomy.

Fig 8

Brief Review
Metastatic Pulmonary Calcification
- Occurs in patients who have hypercalcemia
- Associated disease
- Chronic renal failure
- Intraosseous malignant neoplasm
- Kidney and liver transplantation
- Primary hyperparathyoidism
- Hypervitaminosis D
- Excess exogenous administration of calcium and vitamin D
- Especially common in patients undergoing maintenance hemodialysis

# Pathophysiology
- Deposits of calcium phosphate in alveolar septa and the walls of small pulmonary vessels and bronchi

# Manifestations
- Radiography : normal to airspace nodules or patchy areas of parenchymal opacification in both lungs.
- CT : Fluffy, poorly defined nodular opacities, mainly upper lung zone.
Stippled, diffuse, or occasionally ring-like calcification of nodules.
Calcified vessel in chest wall.
Extensive ground-glass opacities, patchy consolidation.
References
1. Imaging of the Chest, Muller and Silva, SAUNDERS ELSEVIER, p.878-880
2. Metastatic Calcification, J HK Coll Radiol 2002;5:186-189
Keywords
Lung, Multiple organ, Metabolic and storage lung disesae,

No. of Applicants : 104

▶ Correct Answer : 58/104,  55.8%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kang buk samsung hospital, department of radiology , Korea (South) Hyojin Lim
  • - SMG-SNU boramae medical center , Korea (South) Kwang Nam Jin
  • - Assam medical college , India Karunakaran M
  • - Goa Medical College , India Paresh Desai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - hospital Sao Paulo , Brazil israel missrie
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Osaka University , Japan Osamu Honda
  • - SMC , Korea (South) Jihoon Cha
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - CHU Montrl , Canada nicolas gautier
  • - Department of Radiology, University of Alabama at Birmingham , United States Yukihiro Nagatani
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Saga University , Japan Ryoko Egashira
  • - uniradiology , Australia bimal parameswaran
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - KKUH , Saudi Arabia JAMAL KAID
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - partner, aditya imaging centre , India vivek patel
  • - KOREA UNIVERSITY ANSAN HOSPITAL , Korea (South) SEUNAH LEE
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - University of British Columbia , Canada Amr Ajlan
  • - NTUH , Taiwan Kuei-pin Chung
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Samsung Medical Center , Korea (South) Sang Yu Nam
  • - Kangnam severance hospital , Korea (South) Song Min
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - KING KHALID UNIVERSITY HOSPITAL,RIYADH , Saudi Arabia NABIL GHALEB
  • - SacrCoeur, MTL , Canada Andrea Ojanguren
  • - Busan Paik hospital, Inje university , Korea (South) Hye Jin Baek
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Asan Medical Center , Korea (South) Seong Yun Kim
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Assam Medical college , India samudra borah
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - Kyungpook National Univ. Hospital , Korea (South) Sang-yub Lee
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - All India Institute of medical sciences , India Justin Moses
  • - National Taiwan University Hospital, Traumatology , Taiwan Chin-Chung Shu
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Assam Medical College , India Pramod K.G
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
▶ Correct Answer as Differential Diagnosis : 6/104,  5.8%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - CHU Nancy , France Sab Ariane
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