J Korean Soc Radiol.  2013 Jun;68(6):473-477. 10.3348/jksr.2013.68.6.473.

Rapid Progression of Metastatic Pulmonary Calcification and Alveolar Hemorrhage in a Patient with Chronic Renal Failure and Primary Hyperparathyroidism

• Yoon EJ
• Kim DH
• Yoon SH
• Suk EH

• KMID: 2002898
• DOI: http://doi.org/10.3348/jksr.2013.68.6.473

Abstract

Metastatic pulmonary calcification (MPC) is common in patients with chronic renal failure. The authors experienced a patient with chronic renal failure and primary hyperparathyroidism by parathyroid adenoma accompanied with rapid progressions of MPC and alveolar hemorrhage. Recent chest radiographs, compared with previous chest radiographs, showed rapid accumulation of calcification in both upper lungs. Following up on the high-resolution CT scan after five years demonstrates more increased nodules in size and ground glass opacity. The patient was diagnosed with MPC and alveolar hemorrhage by transbronchial lung biopsy. We assumed rapid progression of MPC and alveolar hemorrhage in underlying chronic renal failures could be a primary hyperparathyroidism which may be caused by parathyroid adenoma detected incidentally. Therefore parathyroid adenoma was treated with ethanol injections. Herein, we have reported on CT findings of MPC with alveolar hemorrhage and reviewed our case along with other articles.

MeSH Terms

Biopsy
Ethanol
Glass
Hemorrhage
Humans
Hyperparathyroidism, Primary
Kidney Failure, Chronic
Lung
Parathyroid Neoplasms
Renal Insufficiency
Thorax
Ethanol

Figure

• 

  Fig. 1 A 50-year-old male with chronic renal failure having metastatic pulmonary calcification. A. Chest radiographs (upper image five years ago, middle and lower images during recent six months, respectively) show more prominent multiple nodules with calcification and rapid progression of metastatic pulmonary calcification in both mid- and upper-lung fields during the recent several months. B. HRCT five years ago shows ill-defined nodules with ground glass opacity in both upper lung fields without calcification. C. HRCT scan (upper image) at last admission shows poorly defined nodular opacities and ground glass opacities. Mediastinal window image with no contrast injection (lower image) demonstrate definite nodular calcifications (arrows) compared with the previous CT scan. D. H&E stained section of the lesion obtained by bronchoscopic biopsy shows calcium deposits as black spots in the alveolar wall and bronchiolar wall (arrows). E. 99mTcO4 bone scan shows localized radiotracer accumulation representing metastatic pulmonary calcification in both upper lung fields. F. 99mTc-MIBI parathyroid scan shows localized hyperdense accumulation demonstrating adenoma at the right lower pole of the thyroid (arrow). Note.-HRCT = high-resolution CT, MIBI = methy-isobutyl-isonitrile

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