Atypical radiological manifestation of pulmonary metastatic calcification

Abstract

Metastatic pulmonary calcification refers to calcium deposition in the normal pulmonary parenchyma and this deposition is secondary to abnormal calcium metabolism. The most common radiologic manifestation consists of poorly-defined nodular opacities that are mainly seen in the upper lung zone. We present here a case of metastatic pulmonary calcification that manifested as atypical, dense, calcium deposition in airspaces within the previously existing consolidation in the bilateral lower lobes, and this process was accelerated by pneumonia-complicated sepsis in a patient with hypercalcemia that was due to hyperparathyroidism.

Fig. 1

Metastatic calcification in 48-year-old woman. A. Mediastinal window image of transverse CT scan obtained at level of liver dome and at time of admission shows airspace consolidation in bilateral lower lobes. Note absence of calcification within consolidation at this time. B. Twenty-seven-day-interval follow-up CT scan obtained at level similar to A and after weaning patient from mechanical ventilation demonstrates well-defined bilateral lower lobar consolidation that contains diffuse tissue deposition of calcium, and this is limited to areas of previous consolidation. In addition, scattered calcium deposition was noticed within myocardium. C. Anterior and posterior bone scan images show intense mass-like soft tissue uptake (arrows) of Tc-99m MDP in both lower lung zones and diffusely increased uptakes along stomach wall (arrowheads) without any abnormal bone uptake. D. Alveolar walls are deposited with basophilic spicules of calcium (arrows). Note fibrous tissue within alveolar spaces (Hematoxylin & Eosin staining, ×400).