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Weekly Chest CasesArchive of Old Cases

Case No : 986 Date 2016-09-19

  • Courtesy of Ji Young Rho, MD / CHA Bundang Medical Center, CHA University, Sungnam, Korea
  • Age/Sex 31 / M
  • Chief ComplaintChest pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Diffuse pulmonary ossification
Radiologic Findings
Chest radiography shows diffuse reticular interstitial pattern of increased opacities predominantly in the middle and lower lung zones (Fig. 1). Note the right pneumothorax. Axial CT images with lung window setting show small nodules with somewhat linear or branching opacities in peripheral and peribronchial distribution. (Fig. 2 and 3). Axial CT images with mediastinal window setting show foci of calcifications in some of the nodules and linear opacities (Fig. 4 and 5).
Wedge resections of the RML and RLL were done to establish a diagnosis, and the lesions were diagnosed as diffuse pulmonary ossification.
Brief Review
Diffuse pulmonary ossification is an uncommon condition that is characterized by metaplastic bone formation in the lung parenchyma (1). Luschka (2) first described diffuse pulmonary ossification in 1856, and lately, two types of the disease have been distinguished: dendriform and nodular form. Dendriform ossification may be associated with a history of inflammation, fibrosis, or lung injury, and is characterized by coral-like dendritic pattern on high-resolution computed tomography (HRCT) scan (1, 3, 4). Nodular ossification has been encountered in the clinical setting of cardiac disease and passive congestion, showing smoothly contoured, lobulated nodules on HRCT scan (1, 3, 4).
Diffuse pulmonary ossification usually occurs in the context of a pre-existing pulmonary, cardiac, or metabolic disorder. Idiopathic diffuse pulmonary ossification is a very rare disorder that usually occurs in men aged 40-60 years. Patients are usually asymptomatic but mild symptoms, restrictive pulmonary physiology, and impaired lung transfer factor have been described (5).
The presence of pulmonary calcification is often not apparent on radiographs but can usually be seen on HRCT scanning (5).
References
1. Kanne JP, Godwin JD, Takasugi JE, Schmidt RA, Stern EJ. Diffuse pulmonary ossification. J Thorac Imaging 2004;19:98–102
2. Luschka H. Ramified ossification of the pulmonary parenchyma. Wirchows Arch 1856; 10:500–505.
3. Peros-Golubicić T, Tekavec-Trkanjec J. Diffuse pulmonary ossification: an unusual interstitial lung disease. Curr Opin Pulm Med. 2008;14:488-92
4. Marchiori E, Souza AS Jr, Franquet T, Müller NL. Diffuse high-attenuation pulmonary abnormalities: a pattern-oriented diagnostic approach on high-resolution CT. AJR Am J Roentgenol. 2005 ;184:273-82.
5. Ryan CF, Flint JD, Müller NL. Idiopathic diffuse pulmonary ossification. Thorax 2004;59:1004
Keywords
Lung, Metabolic and storage lung disesae,

No. of Applicants : 84

▶ Correct Answer : 25/84,  29.8%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - NIMS, Hyderabad , India Amit Dadhania
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Pusan National University Hospital , Korea (South) LEE YOU JIN
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Korea university Guro hospital , Korea (South) Hyun Ji Lee
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Asan Medical Center , Korea (South) Chan Ho Park
  • - GHICL , France manuel toledano
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Korea university medical center, guro hospital , Korea (South) Lee chong
  • - Korea university medical center, guro hospital , Korea (South) JINWOO HAN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
▶ Correct Answer as Differential Diagnosis : 10/84,  11.9%
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - 異⑸ , Korea (South) 蹂€
  • - Chungbuk national university , Korea (South) Yong Kim
  • - Centre Hospitalier Regional de Lanaudiere , Canada Matthieu Storme
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - CHU Poitiers , France CHAN paul
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - chungbuk university hospital , Korea (South) 瑜˜
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