Dendriform Pulmonary Ossification Research Articles

Dendriform Pulmonary Ossification in a Young Man: A Case Report

Dendriform Pulmonary Ossification in a Young Man: A Case Report

Idiopathic dendriform pulmonary ossification as the phenotype of interstitial lung abnormalities: CT–pathologic correlation and prevalence

Background and purposeIdiopathic dendriform pulmonary ossification (DPO) is mostly asymptomatic, and detected incidentally in lung CT. There have been no reports on the precise CT–pathologic correlation and the prevalence of idiopathic DPO. This study aimed to clarify the histological background and prevalence of idiopathic DPO.Materials and methodsSixteen patients with histologically confirmed idiopathic DPO (12 men and 4 women; mean age, 38.8 years; range 22–56 years) were identified in a nationwide epidemiological survey. Local HRCT findings of pre-biopsy examinations, such as branching, round, linear structures with or without high attenuation were compared side by side with histological findings. The attenuation of branching, round, and linear structures was classified into three-point levels on bone window images (width, 2500 HU; level, 500 HU). Furthermore, we collected continuous pulmonary CT images of 8111 cases for checking up metastasis from extrathoracic malignancy at a single institution, and evaluated the prevalence of interstitial lung abnormalities (ILAs) and DPO.ResultsIn all 16 cases, branching (n = 15, 93%), round (n = 5, 31%), or linear (n = 5, 31%) structures were identified, histologically corresponding to dendriform ossification and cicatricial organizing pneumonia (OP)/fibrosis. Histologically, ossification was confirmed in all the 16 patients. However, in two cases, a highly attenuated structure could not be detected on the pre-biopsy CT of the same area. Regarding the prevalence of idiopathic DPO, 283 (3.5%) of 8111 patients had ILAs, of which a total of 26 (0.3% of all cases, 9.2% of ILAs cases) had DPO.ConclusionIdiopathic DPO showed linear or branching structures with or without high attenuation on CT, corresponded to ossification, cicatricial OP/fibrosis. DPO was seen in 9.2% of ILAs cases. Idiopathic DPO is one of pathologic phenotypes of ILAs.

Dendriform pulmonary ossification associated with severe SARS-CoV-2 pneumonia

Dendriform pulmonary ossification is an uncommon entity in which there is metaplastic bone formation in the lungs. Cicatricial organizing pneumonia has been described as one of its causes. We present the case of four patients who developed dendriform pulmonary ossification after having severe SARS-CoV-2 pneumonia.

A very rare pulmonary pathology from symptom to diagnosis: Dendriform pulmonary ossification

A very rare pulmonary pathology from symptom to diagnosis: Dendriform pulmonary ossification

Idiopathic dendriform pulmonary ossification incidentally found in a patient with gastroesophageal reflux disease: Case report and literature review

Introduction: Diffuse pulmonary ossification was firstly described by Luschka in 1856. It has two distinct patterns with different clinical, radiological, and histological associations: nodular pulmonary ossification (NPO) and dendriform pulmonary ossification (DPO). Dendriform pulmonary ossification is described by the presence of branching metaplastic osseous spicules usually with bone marrow elements. Dendriform pulmonary ossification is described by the presence of branching metaplastic osseous spicules usually with bone marrow elements. Dendriform pulmonary ossification can occur as idiopathic or in association with chronic lung diseases. Idiopathic DPO is a rare entity and has association with chronic gastric acidity. Case Report: A 36-year-old gentleman, unknown to have any medical illness, was incidentally found to have bilateral diffuse high-density lung opacities during workup for back pain. The patient was asymptomatic. High resolution computed tomography (HRCT) of the chest showed bilateral ossified tiny branching opacities mainly involving the lower lobes. Histologically, the sections showed lung parenchyma with mature bone formation in the interstitial pulmonary spaces with fatty marrow in some of the bony spicules. Complementary upper gastrointestinal study was conducted confirming the presence of high-volume gastro-esophageal reflux. Conclusion: Dendriform pulmonary ossification is a rare entity that can cause serious complications such as respiratory failure. Thus, awareness of it as a differential diagnosis of chronic lung disease is necessary. More studies are needed to establish treatment guidelines and long-term prognosis.

WHEN LUNG BECOMES BONE: A RARE CASE OF DENDRIFORM PULMONARY OSSIFICATION

WHEN LUNG BECOMES BONE: A RARE CASE OF DENDRIFORM PULMONARY OSSIFICATION

Nationwide retrospective observational study of idiopathic dendriform pulmonary ossification: clinical features with a progressive phenotype

BackgroundDiffuse pulmonary ossification is a specific lung condition that is accompanied by underlying diseases. However, idiopathic dendriform pulmonary ossification (IDPO) is extremely rare, and the clinical features remain unclear. In...

Needles in the Lungs: An Autopsy Case of Pulmonary Ossification in a Putrefied Body

Forensic autopsy is performed to investigate a death. However, this is difficult in some cases, particularly in putrefied bodies. Pulmonary ossification is a rare pathological process, characterized by progressive and metaplastic ossification, which leads to the formation of small bony fragments in the pulmonary tissue. This condition can develop within the pulmonary tissues that are injured due to various causes. Metastatic and dystrophic calcification occur in normal tissues in conditions of deranged calcium metabolism and dead or degenerative tissue, respectively. Here, we describe the case of a 54-year-old man who lived alone and whose putrefied body was discovered by his landlord. A forensic pathologist identified needle-like sharp materials in both the lower lobes of the lungs during autopsy. Microscopic examination revealed dendriform pulmonary ossification with calcification. After autopsy, his medical history, including chronic kidney disease, was recorded by forensic pathologist. A review of his past medical history and comprehensive postmortem examination findings of the gross dissection, microscopic examination, and postmortem laboratory tests led to the determination of the cause of death as renal problems.

Good News for Patients With Dendriform Pulmonary Ossification

Dendriform pulmonary ossification (DPO), first described by Luschka1 in 1856, is a rare and typically indolent disease that is more often found at time of autopsy rather than ante mortem. A majority of cases are secondarily associated with lung pathologic processes, such as fibrotic lung diseases, or other conditions, such as gastroesophageal reflux disease, infection, cancer, medications, and immune-mediated injury. The pathophysiologic mechanism of DPO is poorly understood; however, it is believed that activity of bone morphogenetic protein/osteoblasts results in ectopic bone formation with characteristic features.

Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia.

Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia.

Accelerated Pulmonary Ossification as a Sequela of SARS-CoV-2 Pneumonia

HomeRadiology: Cardiothoracic ImagingVol. 3, No. 2 PreviousNext Images in Cardiothoracic ImagingFree AccessPulmonary ImagingAccelerated Pulmonary Ossification as a Sequela of SARS-CoV-2 PneumoniaBeatriz García Moreno , Guadalupe Buitrago Weiland, María Luisa Sánchez Alegre, Jhon Edilberto Vanegas RodríguezBeatriz García Moreno , Guadalupe Buitrago Weiland, María Luisa Sánchez Alegre, Jhon Edilberto Vanegas RodríguezAuthor AffiliationsFrom the Department of Radiology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain.Address correspondence to B.G.M. (e-mail: [email protected]).Beatriz García Moreno Guadalupe Buitrago WeilandMaría Luisa Sánchez AlegreJhon Edilberto Vanegas RodríguezPublished Online:Apr 1 2021https://doi.org/10.1148/ryct.2021200598MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In This case illustrates extensive dendriform lung ossification manifesting after SARS-CoV-2 pneumonia. Organizing pneumonia is an established CT finding in subacute SARS-CoV-2 infection (1,2), usually manifesting as bilateral consolidations (80%–95% of the cases) in a predominantly peripheral or peribronchial distribution, sometimes sparing the subpleural regions (3). Histologic analysis reveals plugs of fibroblastic tissue filling bronchioles and airspaces (3,4), which usually disappear after steroid treatment. However, fibromyxoid tissue may progress to fibrosis, a condition recently described as “cicatricial organizing pneumonia (4–6).” Some of these cases may evolve with pathologic osseous metaplasia, seen on imaging as nodular and branching calcifications, described as dendriform pulmonary ossification (5). This finding is usually seen in patients with underlying lung fibrosis, most commonly in usual interstitial pneumonia, and it is considered as a marker of chronicity and severity of lung fibrosis (7).Differential diagnoses include dystrophic calcifications, metastatic calcifications, and pulmonary alveolar microlithiasis. Dystrophic calcifications occur in diseased lung, in the settings of granulomatous infections, sarcoidosis, occupational lung diseases, and metabolic diseases (eg, as amyloidosis). Metastatic calcifications occur in normal lung due to hypercalcemia secondary to end-stage kidney disease. The differential diagnosis also includes nodular ossification seen in patients with chronic venous lung congestion (8). Normal renal function, phosphate calcium homeostasis, and the absence of any relevant past medical history or concomitant diseases excluded other causes of lung calcification/ossification in this case (Figs 1, 2).Figure 1: Images in a 49-year-old man who presented to the emergency department with SARS-CoV2 infection. A and B, Non–contrast-enhanced chest CT scans obtained 1 month after the onset of symptoms show multifocal peribronchovascular and peripheral consolidation, relatively sparing the subpleural region, consistent with organizing pneumonia. Follow-up chest CT was performed 6 months after steroid treatment. C, Axial and, D, coronal CT images show multiple micronodular calcifications within faint ground-glass opacities.Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: Bone window images in same patient. Comparison between A, initial and, B, follow-up CT on axial maximum intensity projection images shows interval development of micronodular and branching calcifications, confirmed on C, coronal and, D, magnified axial views. Follow-up lung function testing revealed decreased diffusion capacity.Figure 2:Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: B.G.M. disclosed no relevant relationships. G.B.W. disclosed no relevant relationships. M.L.S.A. disclosed no relevant relationships. J.E.V.R. disclosed no relevant relationships.Keywords: CT, Lung, Thorax Authors declared no funding for this work.

Histologically Proven Dendriform Pulmonary Ossification: A Five-case Series.

Dendriform pulmonary ossification (DPO) is a rare condition characterized by metaplastic bone formation in the lung parenchyma. It has been reported to be often associated with primary lung diseases, such as usual interstitial pneumonia (UIP) or chronic aspiration of gastric acid; however, its clinical features and pathophysiology remain unclear, especially in idiopathic cases. We herein report five DPO cases, including three with an idiopathic origin. In all cases of idiopathic DPO, the pathological and radiological examinations showed localized pulmonary lesions suggesting inflammation or hemorrhaging.

IDIOPATHIC DIFFUSE PULMONARY OSSIFICATION: A RARE CAUSE OF CALCIFIED PULMONARY NODULES

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Idiopathic diffuse pulmonary ossification is an extremely rare disease that often presents incidentally on chest imaging. While the initial course can often be indolent, the disease course can be severe, and in some cases, fatal. Here, we describe a case of a 21-year-old female who was incidentally diagnosed with diffuse pulmonary ossification. CASE PRESENTATION: The patient underwent tuberculin skin test for school clearance and was noted to have induration to 16 mm with subsequent negative QuantiFERON gold testing. Chest radiograph showed diffuse bilateral peribronchial thickening and nodular interstitial abnormality. The patient reported mild progressive dyspnea on exertion and intermittent dry cough. Her vital signs were unremarkable including an oxygen saturation of 97% on room air. On exam, her lungs were clear to auscultation. Initial computed tomography (CT) scan of the chest showed extensive bilateral centrilobular and peribronchvascular nodules with varying levels of calcification (image 1). Repeat CT scan at 3 months showed no change. Laboratory investigations including calcium, phosphate, sputum acid-fast bacilli, fungal serologies, and rheumatologic screen were normal. Spirometry showed an isolated mild reduction in the DLCO. Bronchoscopy with transbronchial cryobiopsy of the RLL showed pulmonary parenchyma with focal ossification without granulomas, malignancy or amyloid. Cultures were negative. DISCUSSION: Diffuse pulmonary ossification involves the formation of mature bone in the lung and occurs in two forms: nodular and dendriform, both of which can have idiopathic and secondary forms [1, 2]. Ossification typically presents in older men, though has been reported in women or younger adults. Commonly, patients present with absent to minimal symptoms of dyspnea and radiographic findings are out of proportion to symptoms. Spirometry testing is often initially normal but can develop a restrictive pattern with decreased DCLO in later stages. Chest imaging findings include bilateral diffuse calcified micronodules or dense ground glass opacities, with predilection for the lower lobes. Pathology typically reveals ossification and calcification within the alveoli. In later stages, alveolar septal thickening and interstitial fibrosis may develop. Diagnosis can often be made on imaging findings alone, though it can be confirmed with bronchoscopic or surgical biopsy if diagnosis is uncertain. Therapies target lowering serum calcium levels, though no treatments have been shown to affect the progression of disease. For patients with a more aggressive course, lung transplant may be considered [3]. CONCLUSIONS: Pulmonary ossification is a rare, often asymptomatic disorder, that should be suspected in patients with characteristic imaging findings. Early identification can help to monitor progression, though no clear disease modifying therapies have been identified. Reference #1: 1.Tseung J, Duflou J. Diffuse pulmonary ossification: an uncommon incidental autopsy finding. Pathology 38: 45-48, 2006. Reference #2: 2. Reddy TL, von der Thüsen J, Walsh SL. Idiopathic dendriform pulmonary ossification. J Thorac Imaging 27: W108-W110, 2012. Reference #3: 3. Matsuo H. et al, Progressive Restrictive Ventilatory Impairment in Idiopathic Diffuse Pulmonary Ossification Intern Med. 2018 Jun 1; 57(11): 1631–1636 DISCLOSURES: No relevant relationships by Jessica Channick, source=Web Response My spouse/partner as a Consultant relationship with Actelion Please note: $20001 - $100000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee My spouse/partner as a Consultant relationship with Bayer Please note: $5001 - $20000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee No relevant relationships by Tamas Dolinay, source=Web Response

Dendriform pulmonary ossification: a case report

Dendriform pulmonary ossification: a case report

A Case of Idiopathic Dendriform Pulmonary Ossification Diagnosed by a Thoracoscopic Lung Excisional Biopsy

A Case of Idiopathic Dendriform Pulmonary Ossification Diagnosed by a Thoracoscopic Lung Excisional Biopsy

Dendriform Pulmonary Ossification.

Dendriform Pulmonary Ossification.

Dendriform Pulmonary Ossification in the Absence of Usual Interstitial Pneumonia: CT Features and Possible Association With Recurrent Acid Aspiration.

Dendriform pulmonary ossification (DPO) is a rare lung disease in which mature bone is present in the peripheral interstitium of the lung. It typically occurs in patients with usual interstitial pneumonia (UIP). We assessed patients with CT findings of DPO without UIP to determine possible causative factors and to assess the clinical and CT course. We hypothesized that DPO without UIP would be a unique entity. We retrospectively reviewed CT reports for the word "ossification." Two observers reviewed each examination for micronodules 1-5 mm in diameter in the peripheral interstitium (subpleural and perifissural spaces and interlobular septa), some of which had high attenuation on mediastinal windows, presence of contiguous clusters of nodules resulting in a branching pattern, and lack of findings of UIP or focal lung disease. We reviewed the electronic medical records and follow-up CT and clinical information in all eligible patients. The study population consisted of 52 men with a median age of 79 years old. Seventy-five percent of the patients had gastroesophageal reflux disease, obstructive sleep apnea, or a chronic neurologic disorder. No progressive pulmonary symptoms were attributed directly to DPO, and no patient developed pulmonary fibrosis or suffered clinical decline from DPO. CT showed minimal progression or remained stable at follow-up (77% for at least 1 year, 25% for over 4 years). DPO in the absence of UIP occurs in elderly men and appears to be associated with chronic aspiration of gastric acid. The course is indolent.

Recurrent pneumothorax related to diffuse dendriform pulmonary ossification in genetically predisposed individual

Diffuse pulmonary ossification (DPO) is a rare disease with unknown pathogenesis, clinical manifestations, and treatment options. This report describes the diagnosis of DPO in an otherwise healthy 26‐year‐old man with recurrent spontaneous pneumothorax. His father was diagnosed with a similar lung condition in his 30's with computed tomography (CT) images that were strikingly similar to those of the patient. This report suggests that DPO can induce spontaneous pneumothorax and its pathogenesis may have a possible genetic predisposition that needs further research.

Dendriform pulmonary ossification visualised by scanning acoustic microscope

A 45-year-old man was referred to our facility because of an abnormal shadow on chest radiography. CT revealed a reticular and nodular shadow (figure 1). Histopathology of a surgical lung...

Case of the Season: Usual Interstitial Pneumonia With Dendriform Pulmonary Ossification

Dendriform pulmonary ossification (DPO) is a rare disease characterized by the presence of mature bone in the lung parenchyma with typical radiologic findings of diffuse and numerous calcified nodules. We present two cases of primary DPO complicated by recurrent spontaneous pneumothorax.Case 1 is a 53-year-old male with recurrent pneumothorax unresponsive to chest tube drainage or subtotal pleurectomy via video assisted thoracoscopy (VATS) who was finally treated with talc pleurodesis. Chest computed tomography (CT) revealed bilateral partially calcified reticulonodular opacities with a basal predominance. VATS biopsy revealed patchy foci of fibrous organizing pneumonia with multifocal ossifications confirming DPO histopathology. Pneumothorax recurred on the same side eight months later managed with talc pleurodesis. Case 2 is a 45-year-old Caucasian male who presented for evaluation of three prior spontaneous left-sided pneumothoraces occurring over eight years, treated with chest tube drainage and eventual talc pleurodesis. Chest CT demonstrated multiple high attenuation peripheral branching opacities greatest in the left lower lobe with several nonspecific, non-calcified pulmonary nodules. VATS biopsy revealed cicatrical organizing pneumonia with associated extensive intraalveolar ossification consistent with DPO.We describe two cases of DPO complicated by recurrent pneumothorax and reviewed the world literature. Summarized findings included a propensity for middle-aged males with a generally indolent course though pneumothorax was often refractory to initial chest tube drainage requiring more definitive mechanical management. There was also a predominance of primary disease without associated causes other than several reports of obstructive lung disease (asthma).