Abstract: PUB093
Metastatic Pulmonary Calcification in CKD
Session Information
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Golbus, Ashley, Medical University of South Carolina College of Medicine, Charleston, South Carolina, United States
- Freidin, Natalie T., Medical University of South Carolina Department of Medicine, Charleston, South Carolina, United States
Introduction
Metastatic calcification, that outside of the cardiovascular system, is observed in 0.5-3% of living dialysis patients. In patients with CKD, the mechanism can involve elevated calcium phosphate product, secondary, or tertiary, hyperparathyroidism. Sites of calcification can include the lung tissue (metastatic pulmonary calcification or MPC).
Case Description
We present a case of a 75-year-old male with a history of ESRD on hemodialysis, hypertension, hyperlipidemia, two vessel coronary artery disease s/p recent PCI, severe aortic stenosis, and chronic heart failure, presenting with hypoxemic respiratory failure. Pertinent labs included: PTH 666.8 pg/mL, phosphorous 7.9 mg/dL, and calcium 9.1 mg/dL. Chest X-ray (CXR) demonstrated bilateral multifocal patchy and confluent airspace opacities, favored to represent pulmonary edema. Non-contrast chest CT showed diffuse bilateral ground glass opacities and centrilobular groundglass nodularity (note subpleural sparing) with upper lobe predominant patchy, hyperdense parenchymal consolidations and calcifications (Figure 1). These findings were determined to represent MPC. After a complicated hospital course, valve replacement was not a feasible option and he was transitioned to hospice care and died.
Discussion
MPC is apparent on CXR as confluent or patchy airspace opacities and on CT as diffuse calcified nodules, diffuse or patchy areas of ground glass opacities or consolidation, and confluent high attenuation parenchymal consolidation. In rare cases, this can cause acute respiratory failure with a rapidly progressive chest shadow that mimics pneumonia or pulmonary edema. These imaging findings in patients with chronic kidney disease or on dialysis should lead to consideration of MPC as a differential diagnosis.