대한흉부영상의학회 Weekly Chest Cases

Case No : 716 Date 2011-07-21

Courtesy of Hyun Jin Park / St. Vincent’s Hospital, The Catholic University of Korea
Age/Sex 78 / M
Chief ComplaintDyspnea. Known saccular aneurysm of ascending aorta.

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Diagnosis With Brief Discussion

Diagnosis: Metastatic Calcification in Chronic Renal Failure
Radiologic Findings: Chest PA shows bilateral pleural effusion and cardiomegaly. Dense reticulonodular opacities are seen along periphery of both lower lungs. A mass like shadow is also visible in right paratracheal region. Vascular calcification is seen along aortic knob.
Chest CT scans with a lung window setting show dense reticulonodular opacities and confluent consolidations in the peripheral lungs, mainly lower lobes. Non-enhanced CT scans show evidence of calcification within the lesions. Bilateral pleural effusion is associated.
Contrast enhanced CT scans show extensive vascular calcifications along aorta and a saccular aneurysm with peripheral thrombosis of ascending aorta just before the origin site of right innominate artery. Both kidneys are poorly enhanced with parenchymal shrinkage, indicative of chronic renal failure.
Brief Review: Metastatic calcification refers to the deposition of calcium in soft tissue due to abnormal calcium and phosphate metabolism. It is associated with hypercalcemia and is most common in patients with chronic renal failure and secondary hyperparathyroidism. Metastatic calcification commonly affects the lung, typically interstitial, and can be commonly associated with secondary lung fibrosis. Patients may be asymptomatic or have dyspnea. With appropriate treatment of the underlying abnormality, metastatic calcification may resolve.
Plain radiographs are relatively insensitive in detecting metastatic calcification. In some patients, ill-defined nodules, or patchy areas of increased opacity may be seen. They may or may not appear to be of calcium density. CT can show areas of ground glass opacity, consolidation, or calcification. Numerous fluffy and poorly defined nodules, measuring 3 to 10 mm in diameter, are typical, but opacities can appear focal, lobular, patchy, or diffuse. Even with HRCT, these opacities may not appear calcified. An apical predominance is common, because the apices are more alkaline than the bases, increasing the likelihood of calcium salt precipitation in this region.
References
Keywords: lung, metabolic ans storage,

No. of Applicants : 102

▶ Correct Answer : 31/102, 30.4%

- Seoul National University Hospital , Korea (South) Hyungjin Kim
- Hangang sacred heart hospital , Korea (South) You Mie Han
- Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
- Okayama University , Japan Akihiro Tada
- Assam Medical college , India samudra borah
- CHA Bundang hospital , Korea (South) Hyerin Kim
- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- snuh , Korea (South) Choo jiyung
- IRSA La Rochelle France , France Denis Chabassiere
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Inha University Hospital , Korea (South) Ju Won Lee
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Catholic medical center , Korea (South) hyuna kim
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Chaeil Clinic , Korea (South) Sunkyung Lim
- SNUH , Korea (South) Lee Nyoung Keun
- IMS, BHU,VARANASI , India Sriram Patwari
- Chonbuk National University Hospital , Korea (South) Sungkwan Kim
- radiologist, aditya imaging centre , India vivek patel
- Seoul St Mary Hospital , Korea (South) Chaehun Lim
- NZOZ Diagnostica , Poland Krzysztof Owsianny
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Hanyang university medical center , Korea (South) YOONAH SONG
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Saint Malo , France jean-baptiste Noel
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Bupyong Serim Hospital , Korea (South) Hee Seok Choi
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- KUMC ansan , Korea (South) kihwan kim
- Severance hospital , Korea (South) Saerom Hong

▶ Correct Answer as Differential Diagnosis : 17/102, 16.7%

- Youngdong Hospital , Korea (South) Sang Min Lee
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- University of British Columbia , Canada Amr Ajlan
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- CHRU lille , France manuel toledano
- China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- MUHC , Canada Nesreen Abourokbah
- Fr Mullers Medical College , India Deepu Thomas
- EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
- Montreal , Canada D J
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- Kohka Public Hospital , Japan Akitoshi Inoue
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- radiology , Korea (South) Lee Sanghee
- All India Institute of medical sciences , India Justin Moses
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas

▶ Semi-Correct Answer : 13/102, 12.7%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- 異泥 , Korea (South) heerok jeong
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- chp st martin , France Mariotte benoit
- CNUH , Korea (South) Seoin Jeong
- Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
- Hotel-Dieu Montreal , Canada nicolas gautier
- royal melbourne hospital , Australia kimchi kings
- Mallinckrodt Institute of Radiology , United States Travis Henry
- Osaka University , Japan Hiromitsu Sumikawa
- Chonnam National University Hospital , Korea (South) Jung hyun Kim
- Az Osp Santa Maria Terni , Italy angelo carloni

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 716 Date 2011-07-21

Discussion

No. of Applicants : 102