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.

Pulmonary nodular ossification: A rare and incidental autopsy finding

Pulmonary ossification is also known as metaplastic bone formation. It is a rare and incidental post-mortem finding. Dendriform and nodular pulmonary ossification are the two forms which are recognized, and they are usually associated with systemic or primary lung pathology. Its awareness is necessary to correctly diagnose and differentiate them from other lung pathologies. Histopathology aids in the accurate diagnosis of this dormant entity. Herein, we present an autopsy case of a 37-year-old male with pulmonary ossification discovered incidentally during an autopsy.

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

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

HPR30 Too Ultra-Rare for Care? Orphan Drug Availability for People Living With Ultra-Rare Respiratory Diseases in the Pre, Present and Post Pandemic Worlds

To compare the current and potential availability of treatments for seven index ultra-rare respiratory diseases before and after the peak of the COVID-19 pandemic. At the 2019 ISPOR EU Conference, a landscape review of available treatments for ultra-rare respiratory diseases was presented. Therefore, 3 years on, we sought to explore if treatment access has improved for ultra-rare respiratory diseases. A landscape review was undertaken to seek evidence of treatment developments for ataxia telangiectasia (AT), lymphangiomatosis (LYMF), pulmonary alveolar proteinosis (PAP), pleuroparenchymal fibroelastosis (PPFE), pulmonary alveolar microlithiasis (PAM), pulmonary dendriform ossification (PDO), and light chain deposition disorders (LCDD). Information from clinicaltrials.gov, orpha.net, the EMA and FDA archives and websites of five health technology assessment (HTA) bodies was narratively synthesised. The 2019 clinicaltrials.gov search identified 24 studies and the 2022 search 25 studies at various stages of the clinical trial process. They concerned PAP (2019/2022: 11/10), AT (6/10), LCDD (5/4), LYMF (1/0) and PPFE (1/1). No studies were identified for PAM or PDO. The 2019 review found treatments for AT and PAP were granted orphan status by the EMA and the FDA, and in 2021 the FDA granted orphan status to another AT treatment. Neither search found reimbursement submissions for any of the ultra-rare respiratory disease. There still remains an obvious lack of proven and available treatments for ultra-rare respiratory diseases. Over the past 3 years, only 1 new treatment has been granted regulatory approval and no treatments have yet to result in therapies that are licensed or approved by HTA bodies. It is our hope that as we enter the post-pandemic world, we as industry professionals and researchers start to adequately address the treatment needs of people living with these debilitating conditions.

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...

A rare case of disseminated pulmonary ossification associated with fibrotic lung disease

Abstract Disseminated pulmonary ossification (DPO) is a rare disease characterised by diffuse calcification/ossification of lung parenchyma. Most of the cases are idiopathic, while rest of the cause may have underlying cause like lung congestion, lung injury, lung amyloidosis and interstitial lung disease (ILD). We present a rare case of 58-year-old women with progressive dyspnoea and dry cough. On CT, there were extensive confluent nodular and linear calcification of bilateral lung parenchyma associated with lung fibrosis. Imaging findings lead to diagnosis of DPO associated with idiopathic lung fibrosis. Development of such calcification in ILD is very unusual, therefore knowledge of imaging features of DPO is very crucial for its diagnosis.

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.

DPO: DIFFUSE PULMONARY OSSIFICATION - A DIAGNOSTIC CHALLENGE

Diffuse pulmonary ossification (DPO) is a rare condition of DLD (diffuse lung disease) characterized by the presence of metaplastic ectopic bone in the lungs and is less frequent in patients without a clear background of lung diseases. DPO is characterized by very small calcific nodules, often with bone mature located in both lungs and often in peripheral areas of the lungs. Two patterns of DPO have been recognized dendriform and nodular. The dendriform type is less common and is characterized by a coral-like network of bone spiculae along the alveolar septa and is often related to interstitial fibrosis or chronic obstructive lung disease [1].Recent literature papers indicate that DPO may be a predictor of pulmonary fibrosis, is related to Usual Interstitial Pneumonia (UIP) pattern, and has a higher correlation with Idiopathic Pulmonary Fibrosis (IPF).We present a case of a 41-years-old male with persistent bronchitis who underwent a chest X-ray (CXR) that showed multiple pulmonary small calcified nodules in both lungs. These findings were then defined with a high-resolution computed tomography of the chest (HRCT) that showed multiple small nodules spread in both lungs with a "tree-like pattern". A lung biopsy was performed to confirm the radiological diagnostic hypothesis of DPO, and further pathological examination showed multifocal areas of mature bone tissue within the lung parenchyma.

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.

Pulmonary Heterotopic Ossification Simulating a Pulmonary Hamartoma: Imaging and Pathologic Findings and Differential Diagnosis

Pulmonary Heterotopic Ossification Simulating a Pulmonary Hamartoma: Imaging and Pathologic Findings and Differential Diagnosis

Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia.

Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia.

A Case of Diffuse Pulmonary Ossification Diagnosed by Bronchoscopy

A Case of Diffuse Pulmonary Ossification Diagnosed by Bronchoscopy

P5‐114: A young lady with bones in the lungs –A case of diffuse pulmonary fibro ossification complicated with fungal infection

P5‐114: A young lady with bones in the lungs –A case of diffuse pulmonary fibro ossification complicated with fungal infection

P16‐99: Diffuse pulmonary ossification diagnosed pathologically: A four case series

P16‐99: Diffuse pulmonary ossification diagnosed pathologically: A four case series

Mixed Pneumoconiosis Associated with Diffuse Pulmonary Ossification in Wild Coyotes (Canis latrans)

Mixed pneumoconiosis is a pulmonary disease associated with several inhaled mineral irritants. Dust was found in the alveolar macrophages, alveolar and bronchial walls and pulmonary interstitial tissue of two female coyotes (Canis latrans). The dust contained large amounts of silica, coal, iron and copper particles, which were associated with severe pulmonary disease. Lung injury in the animals was characterized by pulmonary nodules, severe interstitial fibrosis, alveolar hyperplasia and bone formation within alveolar spaces. Coyotes inhaled mineral dust while roaming a field close to three mineral extraction zones. To our knowledge, this is the first report of the concomitant inhalation of multiple minerals in association with diffuse pulmonary ossification in the pulmonary parenchyma of two wild canine animals.

Сhylothorax

Objective — to determine and analyze, on our own experience, effective methods of treating chylothorax.
 Materials and methods. For the last 15 years on the basis of the department of surgical treatment of tuberculosis and invasive diagnostic methods of the SI «National Institute of Phthisiology and Pulmono­logy named after F.G. Yanovsky NAMS of Ukraine» was treated 21 patients with a diagnosis of chylothorax. Among the concomitant pathologies, the following diseases were most often diagnosed: ischemic heart disease 5 (23.8 %) cases, gynecological diseases 7 (32.9 %), obesity 4 (18.8 %).
 Results and discussion. An analysis was perfomed, which allows us to conclude that most often (10 cases, 47.6 %) chylothorax was diagnosed in women as a manifestation of lymphangioleiomyomatosis (LAM). It should be noted that in 4 (36.3 %) patients, LAM was diagnosed only by lung biopsy. In 2 (18.1 %) women, chylothorax was bilateral. In 6 (54.5 %) cases, a history of spontaneous pneumothorax (a characteristic diagnostic sign of LAM). The second place among the causes of chylothorax was by intrathoracic lymph node dissection during surgery for lung cancer. In all 3 (14.2 %) cases, the patients underwent left­sided pulmonectomy. Chylothorax usually developed by about 5—7 days, which coincided with the mobilization of patients and the restoration of adequate nutrition. In 2 (9.5 %) patients, the cause of chylothorax was damage to the thoracic duct during neurosurgical intervention through the transpleural approach. Such chylothorax is characterized by an aggressive course, quickly leads to exhaustion of the patient and requires immediate surgical intervention to ligate the thoracic duct below the level of injury. In 2 (9.5 %) patients, chylothorax was one of the manifestations of idiopathic pulmonary ossification. It should be noted that the diagnosis of pulmonary ossification was established only after a histological examination of a biopsy specimen, while such patients were admitted to the clinic with a diagnosis of recurrent pleurisy. In both cases, it was possible to achieve cessation of lymphorrhea by using parietal pleurectomy and conservative therapy. A feature of these patients is the fact that even with the elimination of chylothorax, moderate manifestations of respiratory failure remained in them. Chylothorax in lymphoproliferative diseases — in 2 cases (9.5 %) was the result of the prevalence of the oncological process, and therefore after its diagnosis, only pleural punctures and symptomatic treatment were performed. In no case was it possible to achieve complete cessation of lymphorrhea. In 1 (4.7 %) patient, idiopathic right­sided recurrent chylothorax was observed with moderate hilar lymphadenopathy. Videothoracoscopic biopsy of the intrathoracic lymph nodes was supplemented with parietal pleurectomy. This made it possible to achieve a reliable cessation of lymphorrhea, however, according to the data of a histopathological study, only reactive nonspecific changes were presented in the lymph nodes. In another 1 (4.7 %) case, on the 4th day after right­sided parietal pleurectomy for chronic pleural tuberculosis, lymphorrhea developed on the side of the operation. Short­term conservative therapy made it possible to achieve a positive result.Thus, the overall effectiveness of the treatment of such a pathological condition as chylothorax was 85.7 %. 
 Conclusions. Chylothorax is a complex medical problem, the effective solution of which depends on a complex of conservative and surgical methods of treatment.The most common cause of chylothorax is lymphangioleiomyomatosis (47.6 %). The overall effectiveness of chylothorax treatment in the clinic is 85.7 %.