Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases.

Luciana Camara Belém,Dante Luiz Escuissato,Luiz Felipe Nobre,Rosana Souza Rodrigues,Bruno Hochhegger,Carolina A Souza,Claudio S Silva,Arthur Soares Souza Jr,Edson Marchiori,Gláucia Zanetti,Marcos Duarte Guimarães,Antônio Carlos Portugal Gomes

doi:10.1590/0100-3984.2016-0123

Abstract

ObjectiveThe aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC).Materials and MethodsWe 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.ResultsThe 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.ConclusionMPC 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.

Highlights

Metastatic pulmonary calcification (MPC) is a metabolic lung disease characterized by the deposition of calcium in normal lung tissue under conditions that directly or indirectly result in hypercalcemia[1,2,3]
Peripheral reticular opacities associated with small calcified nodules were observed in five (21.7%) patients (Figure 5)
Computed tomography (CT) of the chest has been the subject of a series of recent publications in the Brazilian radiological literature[23,24,25,26,27,28,29,30,31]

Summary

Introduction

Metastatic pulmonary calcification (MPC) is a metabolic lung disease characterized by the deposition of calcium in normal lung tissue under conditions that directly or indirectly result in hypercalcemia[1,2,3]. MPC is known to be a long-term complication of chronic renal failure with secondary hyperparathyroidism. Histological changes of MPC are encountered on autopsy in 60–75% of patients who received hemodialysis[1,7,9,10], the condition is much less commonly diagnosed antemortem. This situation is probably the result of the poor sensitivity of standard chest radiographs for the identification of small calcifications, the lack of awareness among clinicians of the imaging manifestations of MPC, and the benign clinical course of the disease[11,12]

Methods

Results

Conclusion