Metastatic pulmonary calcification is a complication of patients with renal failure [1], but is rarely seen after successful renal transplantation. A 51-year-old Japanese male demonstrated progression of diffuse pulmonary ground-glass attenuations over time. He had been treated with oral corticosteroids and immunosuppressants since undergoing left renal transplantation from his mother at 26 years of age. A chest radiograph (fig. 1a and b) and high-resolution computed tomography (fig. 1c, d, e, g and h) showed diffuse centrilobular ground-glass attenuations and partly high-density areas. These findings had slowly worsened over time. 99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy demonstrated high bilateral pulmonary uptake, especially in the upper and posterior lung fields (fig. 1f). This case is considered as continuously progressive metastatic pulmonary calcification after successful renal transplantation.
To date, the comprehensive mechanism of metastatic pulmonary calcification is unknown, but a deposition of a calcium magnesium phosphate complex accumulating in the pulmonary interstitium and bronchovascular tissues is thought to be one mechanism [1]. Additionally, radiological findings of this disease on high-resolution computed tomography mimic other respiratory diseases such as hypersensitivity pneumonia and alveolar microlithiasis; 99mTc-MDP would be helpful in the diagnosis of early pulmonary calcifications [2].
Footnotes
Provenance
Submitted article, peer reviewed.
Statement of Interest
None declared.
- ©ERS 2013