Metastatic pulmonary calcification (MPC) a complication of chronic renal failure.

Metastatic pulmonary calcification (MPC) a complication of chronic renal failure, is particularly diagnosed antemortem, yet may be a significant etiology of pulmonary dysfunction in patients with renal failure. The extent of respiratory distress often does not correlate with the extent of macroscopic calcification. Patients with extensive calcification may be asymptomatic, while others with sly calcification or normal chest radiographs may have morose respiratory compromise. Additionally, the findings in succession chest radiographs may be confused with air-space disease, including pulmonary edema and pneumonia. Radionuclide imaging may expose MPC in the setting of normal chest radiographs, and confirm the diagnosis when there are radiographic findings of air-space disease without macroscopic calcification. We current a patient with bilateral upper lobe disease suspected to show edema or pneumonia, proven to depict MPC on [Tc.sup.99m] MDP scintigraphy with single photon emission comput tomography (SPECT) CT and later at transbronchial biopsy.

Metastatic pulmonary calcification (MPC) fall outs in the setting of chronic renal failure, hemodialysis, and malignant diseases of bone While everyday at autopsy in patients with renal failure, the proces is of ten undiagnosed antemortem. Many patients are asymptomatic, and chest radiographs are many times normal. When the chest radiograph is abnormal, condensed nodular, and/or confluent consolidation mimicking air space disease may be mistaken for pneumonia or pulmonary edema. The early diagnosis of MPC is important, as any patients may develop lethal acute respiratory distress. Previous reports have demonstrated the ability of technetium-99m-labeled bone scanning radionuclides to lay open pulmonary calcification, even in the absence of radiographic abnormality,[1-3] with more [i]or[/i] less authors advocating scintigraphy in the screening evaluation of patients with chronic renal failure and dyspnea of unknown etiology. We ready a case of MPC localized to the lung parenchyma with [Tcsup99m]-MDP scintigraphy using single photon emission comput tomography (SPECT) an application previously not reported for MPC

Case Report

A 60-year-old man with end-stage renal failure, receiving hemodialysis for 23 years, was admitted to the general medicine service for the evaluation of poor appetite and weight los The patient had no complaints referable to the chest and was afebrile with a respiratory rate of 18 The chest was clear to auscultation and percussion. Laboratory studies revealed a normal WBC and differential, BUN of 46 mg/dl serum creatinine of 68 mg/dl calcium of 95 mg/dl and phosphorus of 58 mg/dl Sputum civilizations were negative. Posteroanterior and lateral chest radiographs demonstrated an alveolar proces with flowing together ill-defined opacities resembling consolidation located predominantly in the upper lobes, while a reticulonodular pattern was near in much of the remaining lung parenchyma. In a areas there were ill-defined bilateral pulmonary nodules. Infection was the primary clinical consideration, edema the other Cultures from bronchoalvcolar lavage performed at bronchoscopy were positive for Pseudomonas and coagulase-positive Staphylococcus; however, Gram stain and cultivations of biopsy specimen!;were negative. The patient was febrile to 385 [degrees] C forward hospital day 4, and had 5 febrile intervals with temperatures between 375 [degrees] C and 383 [degrees] C during the remainder of his 51-day hospitalization.

Despite broad-spectrum antibiotic therapy, the chest radiographs did not change. Given the lack of radiographic improvement while receiving antibiotics and no definitive source of infection at bronchoscopy the diagnosis of MPC was considered. Planar [Tcsup99m]-MDP scintigraphy was performed. Three hours after the intravenous administration of 925 M Bq (25 mCi) [Tcsup99m]-MDP plannar images of the head/neck, chest, abdomen, and extremities were obtained, revealing diffuse, increased uptake of the radiotracer in the thorax bilaterally forward both anterior and posterior views, predominantly in the upper lobes and in the stomach (Fig 1) Using a gamma camera (Vision 1024R Summit Nuclear, Twinsburg, Ohio) SPECT investigation of the chest was performed, collecting accounts for 20 to 25 s in each of 64 angles athwart 360 [degrees]. The SPECT images rebuilded in the axial, sagittal, and coronal planes verified that the increased thoracic radiotracer activity seen forward planar images was in the lung parenchyma (Fig 2) and not in the surrounding chest wall. A noncontrast-enhanced chest CT performed forward a scanner (CT/T 9800, GE Medical regularitys Milwaukee) demonstrated multiple calcified pulmonary nodules, predominantly in the upper lobes measuring 2 to 11 mm focal areas of nodular parenchymal abnormality without calcification, and scattered reticular abnormality from first to last the less involved lung (Fig 3) Scattered punctate calcification was also at hand throughout the soft tissues of the chest wall. The final pathology report from bronchoscopic biopsy specimen subsequently demonstrated calcification with alveolar fibrosis. No cause for the patient's excitement was identified.

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