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Metastatic Pulmonary Calcification B
A
A
chest radiograph of a 47-year-old woman with a dry cough and Sophie Timmins, M.D. mild exertional dyspnea showed poorly defined bilateral nodular opacities Michael Hibbert, M.D. in the superior lung fields (Panel A). The patient had undergone renal trans- Royal North Shore Hospital plantation at 23 years of age for an unspecified glomerulonephritis. She had no his- Sydney, NSW, Australia tory of exposure to tobacco or occupational aerosols. An axial computed tomograph-
[email protected] ic scan of the chest showed centrilobular ground-glass nodules and heterogeneous attenuation, features that were suggestive of calcium deposition (Panel B). Results of serum tests revealed increased serum creatinine (285 µmol per liter [3.2 mg per deciliter]), a normal calcium level (2.3 mmol per liter [9.2 mg per deciliter], corrected for the serum albumin level), a normal phosphate level (1.4 mmol per liter [4.3 mg per deciliter]), increased parathyroid hormone (1571 ng per liter), and a low vitamin D level (calcidiol, 13.4 nmol per liter [5.4 ng per milliliter], and calcitriol, 20 pmol per liter [7.7 ng per milliliter]). Bronchoalveolar washings were negative for mycobacterial and fungal infection. On the basis of these findings, the patient received a diagnosis of metastatic pulmonary calcification due to chronic renal impairment and secondary hyperparathyroidism. Results of pulmonary-function tests, which showed mild restriction and moderate diffusion impairment, were consistent with the diagnosis. The patient’s lung function and symptoms have remained stable for 18 months while she has been treated with phosphate binders, vitamin D supplementation, and cinacalcet, a calcimimetic agent.
Copyright © 2010 Massachusetts Medical Society.
n engl j med 363;26
nejm.org
december 23, 2010
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