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Sahafi P, Sabertanha A, Ataei Azimi S, Aryana K, Aghaee A. A Case of Metastatic Pulmonary Calcification Detected on 99mTc-MDP Bone Scan and 99mTc-FAPI Scan. Clin Nucl Med 2024; 49:e441-e443. [PMID: 39102814 DOI: 10.1097/rlu.0000000000005321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
ABSTRACT A 59-year-old woman with recent history of weakness, loss of appetite, and significant weight loss was referred for malignancy workup. On the first day, the patient underwent a 99mTc-MDP scan, which revealed diffuse pulmonary uptake in both lungs. Two days later, 99mTc-FAPI scan was performed and showed diffuse pulmonary uptake in the planar and SPECT/CT images. The study present an interesting case demonstrating FAPI-ligand uptake in metastatic pulmonary calcification.
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Affiliation(s)
- Pegah Sahafi
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Sabertanha
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajad Ataei Azimi
- Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamran Aryana
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atena Aghaee
- From the Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Chen T, Hossain R, Jeudy J, Chelala L, White C. Metastatic Pulmonary Calcification: Single-Center Review of Typical and Atypical Imaging Features. J Comput Assist Tomogr 2024; 48:98-103. [PMID: 37551148 DOI: 10.1097/rct.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this study is to bring attention to an atypical form of metastatic pulmonary calcification, which is conventionally described as a metabolic process with upper lobe predominance in patients with a specific clinical history, which has not been reported as a distinct entity. METHODS Patients with metastatic pulmonary calcification (MPC) were first identified with mPower keyword search, including MPC or metastatic calcifications on computed tomography chest radiological reports. Patients were then filtered on likelihood of MPC based off imaging reports. Images were then reviewed by three senior radiologists for pertinent characteristics such as location of MPC, degree of calcifications and pleural effusions. Based on the predominant location of MPC, cases were labeled as either typical or atypical. Clinical and imaging characteristics relevant to MPC were noted and compared across typical and atypical cases. RESULTS In our study, we describe 25 patients with MPC, 13 defined as typical MPC and 12 with atypical MPC. Through consensus of senior radiologists, MPC was deemed to be mild (52%), moderate (44%), or severe (4%). Twenty-three patients (92%) had underlying renal disease including 21 requiring dialysis at the time of diagnosis. Outside of age at diagnosis, there was no significant clinical difference between the two groups. Evaluation of imaging characteristics (average HU attenuation, 267; range, 186-295), pattern and distribution of calcification, and clinical history strongly supported a diagnosis of atypical MPC. CONCLUSION This study presents several cases of lower lobe subpleural MPC associated with pleural effusions, which has not been reported as a distinct entity, despite comprising a significant portion of MPC cases at our institution.
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Affiliation(s)
- Tina Chen
- From the University of Maryland School of Medicine, Baltimore, MD
| | - Rydhwana Hossain
- From the University of Maryland School of Medicine, Baltimore, MD
| | - Jean Jeudy
- From the University of Maryland School of Medicine, Baltimore, MD
| | - Lydia Chelala
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Charles White
- From the University of Maryland School of Medicine, Baltimore, MD
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3
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Loh TC, Pang YK, Liam CK, Chew MF, Tan JL. Metastatic pulmonary calcification mimicking pulmonary tuberculosis: A case report. Respirol Case Rep 2022; 10:e01030. [PMID: 36090023 PMCID: PMC9434080 DOI: 10.1002/rcr2.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
Metastatic pulmonary calcification (MPC) is characterized by deposition of calcium in the normal lung parenchyma secondary to elevation of serum calcium. Most patients are asymptomatic and routine chest radiograph is not sensitive to make the diagnosis. Further imaging is needed such as computed tomography (CT) which typically shows small centrilobular nodules in the upper lobes. We report a case of a 30-year-old woman with end stage kidney disease who was diagnosed with pulmonary tuberculosis which was then revised to metastatic pulmonary calcification. The CT thorax feature for this patient was atypical for metastatic pulmonary calcification where it demonstrated tree-in-bud nodules suggestive of infection. The final diagnosis was made based on bronchoalveolar lavage which was culture-negative for Mycobacterium and transbronchial lung biopsy demonstrating calcium deposition in the interstitium.
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Affiliation(s)
- Thian Chee Loh
- Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Man Fong Chew
- Department of Pathology, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Jiunn Liang Tan
- Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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4
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Zampieri JF, Pacini GS, Zanon M, Altmayer SPL, Watte G, Barros M, Durayski E, Meirelles GDSP, Guimarães MD, Marchiori E, Souza Junior AS, Hochhegger B. Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography. ACTA ACUST UNITED AC 2019; 45:e20180168. [PMID: 31365682 PMCID: PMC6733725 DOI: 10.1590/1806-3713/e20180168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. METHODS This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. RESULTS Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = -0.13, p = 0.24; r = -0.18, p = 0.10; and r = -0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = -0.29, p < 0.05). CONCLUSIONS Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.
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Affiliation(s)
- Juliana Fischman Zampieri
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gabriel Sartori Pacini
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Matheus Zanon
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Stephan Philip Leonhardt Altmayer
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Guilherme Watte
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Marcelo Barros
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Evandra Durayski
- . Programa de Pós-Graduação em Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Marcos Duarte Guimarães
- . Hospital Heliópolis, São Paulo (SP) Brasil.,. A. C. Camargo Cancer Center, São Paulo (SP) Brasil
| | - Edson Marchiori
- . Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Bruno Hochhegger
- . Laboratório de Pesquisas em Imagens Médicas - LABIMED - Departamento de Radiologia, Pavilhão Pereira Filho, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Programa de Pós-Graduação em Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Inamdar AA, Pulinthanathu R. Metastatic Pulmonary Calcification with Coexisting Non-specific Interstitial Pneumonia: A Rare Case Report and Literature Review. Cureus 2019; 11:e4183. [PMID: 31106083 PMCID: PMC6504019 DOI: 10.7759/cureus.4183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with underlying chronic kidney disease (CKD) often have elevated serum calcium and parathyroid hormones due to compromised kidney function. We present a case of a 63-year-old female non-smoker with a surgical history of three renal transplants (at age 47, 51, and 58) along with thyroidectomy and parathyroidectomy, who came to the emergency department with complaints of a persistent dry cough and shortness of breath for the last two months. The patient had been on immunosuppressive drugs-tacrolimus, prednisolone, and mycophenolic acid-since her first renal transplant as well as on cinacalcet after parathyroidectomy (at age 54). An initial computed tomography (CT) scan demonstrated ground glass opacities in the bilateral upper lobes while bronchoscopy revealed few inflammatory cells without any fungi or bacteria. A repeat CT scan performed five days later due to rapid progression of her clinical symptoms showed worsening of ground glass opacities in the bilateral upper lobes and new nodules in the right middle and lower lung lobes. A wedge lung biopsy revealed metastatic pulmonary calcification (MPC) in the right upper lobe and non-specific interstitial pneumonia (NSIP) in the right lower lobe, confirming the co-existence of two different pathological processes most likely complicating the patient's clinical symptoms. Despite comprehensive medical therapy, the patient's symptoms progressively worsened and she is currently undergoing evaluation for both renal and lung transplants. Our case report not only presents a rare case of MPC coexisting with NSIP but also sheds light on the associated morbidity due to pulmonary symptoms in CKD patients.
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Affiliation(s)
- Arati A Inamdar
- Department of Pathology, RWJBarnabas Health, Livingston, USA
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Teh SP, Ng YL, Yii CAA, Choong HLL, Wong J. Metastatic pulmonary calcification: Experience from a single center in Singapore. Hemodial Int 2018; 22:E63-E67. [PMID: 29608811 DOI: 10.1111/hdi.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/02/2018] [Indexed: 11/28/2022]
Abstract
Metastatic pulmonary calcification (MPC) was seen in 79% of patients with end-stage renal disease (ESRD) during autopsy. However, it is not commonly diagnosed in vivo. Its pathogenesis is not fully understood. We report a retrospective series of 5 cases of MPC from a single center in Singapore. MPC were diagnosed using radiological or histological features. Mean onset of MPC from diagnosis of ESRD was 22.6 ± 3.1 years. One patient remains asymptomatic. Four patients died, one was related to MPC. All patients had calcifications at the lung apices on radiological studies. Three patients with MPC were diagnosed based on radiological features while 2 had histological features. Four patients underwent parathyroidectomy without radiological changes before parathyroidectomy. Median intact parathyroid hormone of this series was 5.6 pmol/L (IQR 1.3-139.4), alkaline phosphatase 74 U/L (IQR 62-461), calcium 2.10 mmol/L (IQR 1.85-2.40), and phosphate 1.30 mmol/L (IQR 0.87-1.63). The observed low iPTH suggests that MPC might occur in low iPTH. Our case series showed MPC might occur in low iPTH after parathyroidectomy, in contrast to existing literature that suggests MPC is diagnosed in patients with elevated iPTH. Parathyroidectomy does not prevent MPC.
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Affiliation(s)
- Swee Ping Teh
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yuen Li Ng
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Chau Ang Anthony Yii
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Jiunn Wong
- Department of Renal Medicine, Singapore General Hospital, Singapore
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7
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Torres PPTES. Metastatic pulmonary calcification: contribution of imaging to noninvasive diagnosis. Radiol Bras 2017; 50:VII-VIII. [PMID: 29085179 PMCID: PMC5656085 DOI: 10.1590/0100-3984.2017.50.5e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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8
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Belém LC, Souza CA, Souza AS, Escuissato DL, Hochhegger B, Nobre LF, Rodrigues RS, Gomes ACP, Silva CS, Guimarães MD, Zanetti G, Marchiori E. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases. Radiol Bras 2017; 50:231-236. [PMID: 28894330 PMCID: PMC5586513 DOI: 10.1590/0100-3984.2016-0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective The aim of this study was to evaluate the high-resolution computed tomography
(HRCT) findings in patients diagnosed with metastatic pulmonary
calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23
cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The
patients were examined between 2000 and 2014 in nine tertiary hospitals in
Brazil, Chile, and Canada. Diagnoses were established by histopathologic
study in 18 patients and clinical-radiological correlation in 5 patients.
Two chest radiologists analyzed the images and reached decisions by
consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules
(n = 14; 60.9%), consolidation with high attenuation
(n = 10; 43.5%), small dense nodules
(n = 9; 39.1%), peripheral reticular opacities
associated with small calcified nodules (n = 5; 21.7%), and
ground-glass opacities without centrilobular ground-glass nodular opacity
(n = 5; 21.7%). Vascular calcification within the chest
wall was found in four cases and pleural effusion was observed in five
cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular
ground-glass nodules, often containing calcifications, followed by dense
consolidation and small solid nodules, most of which were calcified. We also
described another pattern of peripheral reticular opacities associated with
small calcified nodules. These findings should suggest the diagnosis of MPC
in the setting of hypercalcemia.
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Affiliation(s)
| | - Carolina A Souza
- MD, PhD, Ottawa Hospital Research Institute, University of Ottawa, Canada
| | - Arthur Soares Souza
- MD, PhD, Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil
| | | | - Bruno Hochhegger
- MD, PhD, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Luiz Felipe Nobre
- MD, PhD, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Rosana Souza Rodrigues
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ) and Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
| | | | - Claudio S Silva
- MD, MSc, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Marcos Duarte Guimarães
- MD, PhD, A.C.Camargo Cancer Center, São Paulo, SP, and Universidade Federal do Vale do São Francisco (Univasf), Petrolina, PE, Brazil
| | - Gláucia Zanetti
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- MD, PhD, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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9
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Hochhegger B, de Souza VVS, Marchiori E, Irion KL, Souza AS, Elias Junior J, Rodrigues RS, Barreto MM, Escuissato DL, Mançano AD, Araujo Neto CA, Guimarães MD, Nin CS, Santos MK, Silva JLPE. Chest magnetic resonance imaging: a protocol suggestion. Radiol Bras 2016; 48:373-80. [PMID: 26811555 PMCID: PMC4725399 DOI: 10.1590/0100-3984.2014.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the recent years, with the development of ultrafast sequences, magnetic
resonance imaging (MRI) has been established as a valuable diagnostic modality
in body imaging. Because of improvements in speed and image quality, MRI is now
ready for routine clinical use also in the study of pulmonary diseases. The main
advantage of MRI of the lungs is its unique combination of morphological and
functional assessment in a single imaging session. In this article, the authors
review most technical aspects and suggest a protocol for performing chest MRI.
The authors also describe the three major clinical indications for MRI of the
lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and
investigation of pulmonary abnormalities in patients who should not be exposed
to radiation.
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Affiliation(s)
- Bruno Hochhegger
- PhD, Associate Professor, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Klaus Loureiro Irion
- PhD, Consultant Radiologist, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Arthur Soares Souza
- PhD, Professor, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Jorge Elias Junior
- PhD, Associate Professor, Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor, Department of Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | | | - Marcos Duarte Guimarães
- PhD, Professor, Program of Post-graduation stricto sensu, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Carlos Schuler Nin
- MD, Resident in Radiology and Imaging Diagnosis, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcel Koenigkam Santos
- PhD, Attending Physician at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Luiz Pereira E Silva
- PhD, Associate Professor, Department of Medicine and Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Liang Z, Qiu T, Zhao Z, Chen L, She D. Metastatic pulmonary calcification misdiagnosed as a fungal infection: A case report. Mol Clin Oncol 2015; 4:409-412. [PMID: 26998293 PMCID: PMC4774441 DOI: 10.3892/mco.2015.723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/17/2015] [Indexed: 12/29/2022] Open
Abstract
Metastatic pulmonary calcification is a rare lesion, characterized by calcium salt depositing in normal lung tissue. The clinical profile of a case of metastatic pulmonary calcification following renal transplantation was described. A computed tomography scan of the chest revealed ground-glass opacities in bilateral lungs and a node exhibiting a halo in the right upper lobe, which were suspected aspergillus infection. Following examination and therapy, the results of lung biopsy revealed metastatic pulmonary calcification. Although metastatic pulmonary calcification was reported in renal failure patients previously, metastatic pulmonary calcification with cavity lesions has never, to the best of our knowledge, been previously reported. The aim of the present report was to improve the understanding of metastatic pulmonary calcification.
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Affiliation(s)
- Zhixin Liang
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Tian Qiu
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Zhigang Zhao
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Liang'an Chen
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Danyang She
- Department of Respiration, Chinese PLA General Hospital, Beijing 100853, P.R. China
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11
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Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
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Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Amin SB, Slater R, Mohammed TLH. Pulmonary calcifications: a pictorial review and approach to formulating a differential diagnosis. Curr Probl Diagn Radiol 2015; 44:267-76. [PMID: 25812931 DOI: 10.1067/j.cpradiol.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 12/30/2014] [Indexed: 01/15/2023]
Abstract
Pulmonary calcifications encompass a wide range of causes, both common and rare, such as calcified pulmonary nodules from chronic fungal infections and pulmonary alveolar microlithiasis. In this pictorial review, we categorize them based on etiology, which includes neoplastic calcifications, nonneoplastic calcified nodules, and iatrogenic- and exposure-related causes of pulmonary calcifications. We also illustrate the most characteristic imaging findings and outline the clinical implications for each of these entities to provide a sensible approach to pulmonary calcifications.
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Affiliation(s)
- Sagar B Amin
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL.
| | - Robbie Slater
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL
| | - Tan-Lucien H Mohammed
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, UF Health Shands Hospital, Gainesville, FL
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Belém LC, Zanetti G, Souza AS, Hochhegger B, Guimarães MD, Nobre LF, Rodrigues RS, Marchiori E. Metastatic pulmonary calcification: state-of-the-art review focused on imaging findings. Respir Med 2014; 108:668-76. [PMID: 24529738 DOI: 10.1016/j.rmed.2014.01.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 11/16/2022]
Abstract
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 membranes. MPC is seen at autopsy in 60-75% of patients with renal failure. It is often asymptomatic, but can potentially progress to respiratory failure. Chest radiographs are frequently normal or demonstrate confluent or patchy airspace opacities. Three patterns visible on high-resolution computed tomography have been described: multiple diffuse calcified nodules, diffuse or patchy areas of ground-glass opacity or consolidation, and confluent high-attenuation parenchymal consolidation. The relative stability of these pulmonary infiltrates, in contrast to infectious processes, and their resistance to treatment, in the clinical context of hypercalcemia, are of diagnostic value. Scintigraphy with bone-seeking radionuclides may demonstrate increased radioactive isotope uptake. The resolution of pulmonary calcification in chronic renal failure may occur after parathyroidectomy, renal transplantation, or dialysis. Thus, the early diagnosis of MPC is beneficial. The aim of this review is to describe the main clinical, pathological, and imaging aspects of MPC.
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Affiliation(s)
| | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | - Rosana Souza Rodrigues
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
| | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Abstract
Neste trabalho é relatado o caso de uma paciente do sexo feminino de 48 anos de idade, portadora de insuficiência renal crônica, em diálise há 13 anos, tendo iniciado o quadro com hemoptise, febre, tosse produtiva e dispneia aos grandes esforços. A radiografia de tórax apresentou opacidades mal definidas predominando nos terços médios e inferiores dos pulmões. A tomografia computadorizada de tórax evidenciou opacidades em vidro fosco associadas com nódulos centrolobulares mal definidos, com atenuação em vidro fosco. A paciente foi submetida a lavagem broncoalveolar, que foi negativa para micobactérias e fungos. Com base nesses achados, foi realizada biópsia pulmonar a céu aberto, que revelou calcificação pulmonar metastática.
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Affiliation(s)
| | | | - Edson Marchiori
- Universidade Federal Fluminense; Universidade Federal do Rio de Janeiro, Brasil
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[Metastatic pulmonary calcification: rare disease, difficult diagnosis, potentially severe prognosis]. Rev Mal Respir 2012; 29:737-8. [PMID: 22742459 DOI: 10.1016/j.rmr.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 04/30/2012] [Indexed: 11/22/2022]
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