Hiroshi Ishimoto

Hiroshi Mukae

Kazuhiro Yatera

Toshinori Kawanami

European Respiratory Review

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IMAGES IN RESPIRATORY MEDICINEProgressive metastatic pulmonary calcification aftersuccessful renal transplantationMetastatic pulmonary calcification is a complication of patientswith renal failure [1], but is rarely seen after successful renaltransplantation. A 51-year-old Japanese male demonstratedprogression of diffuse pulmonary ground-glass attenuationsover time. He had been treated with oral corticosteroids andimmunosuppressants since undergoing left renal transplanta-tion 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 findingshad slowly worsened over time. 99mTc-methylene diphospho-nate (99mTc-MDP) scintigraphy demonstrated high bilateralpulmonary uptake, especially in the upper and posterior lungfields (fig. 1f). This case is considered as continuouslyprogressive metastatic pulmonary calcification after successfulrenal transplantation.FIGURE 1. A chest radiograph from a) January 2003 and b) January 2012, and a computed tomography scan from d, g) December 2005 and c, e, h) November 2011showing calcified nodular lesions and centrilobular ground-glass attenuations in the bilateral lungs. f) 99mTc-methylene diphosphonate scintigraphy from November 2011:high uptake of the agent was predominantly observed in the upper lung field and back area.Eur Respir Rev 2013; 22: 127, 98–99DOI: 10.1183/09059180.00007712CopyrightERS 201398 VOLUME 22 NUMBER 127 EUROPEAN RESPIRATORY REVIEWTo date, the comprehensive mechanism of metastatic pulmon-ary calcification is unknown, but a deposition of a calciummagnesium phosphate complex accumulating in the pulmon-ary interstitium and bronchovascular tissues is thought to beone mechanism [1]. Additionally, radiological findings of thisdisease on high-resolution computed tomography mimic otherrespiratory diseases such as hypersensitivity pneumonia andalveolar microlithiasis; 99mTc-MDP would be helpful in thediagnosis of early pulmonary calcifications [2].Kazuhiro Yatera, Toshinori Kawanami, Hiroshi Ishimoto andHiroshi MukaeDept of Respiratory Medicine, University of Occupational andEnvironmental Health, Japan, Fukuoka, Japan.Correspondence: K. Yatera, Dept of Respiratory Medicine,University of Occupational and Environmental Health, Japan,1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555,Japan. E-mail: yatera@med.uoeh-u.ac.jpStatement of Interest: None declared.Provenance: Submitted article, peer reviewed.REFERENCES1 Chan ED, Morales DV, Welsh CH, et al. Calcium deposition with orwithout bone formation in the lung. Am J Respir Crit Care Med 2002;165: 1654–1669.2 Brodeur FJ, Kazerooni EA. Metastatic pulmonary calcificationmimicking air-space disease: technetium-99m-MDP SPECT imag-ing. Chest 1994; 106: 620–622.DOI: 10.1183/09059180.00007712EUROPEAN RESPIRATORY REVIEW VOLUME 22 NUMBER 127 99

Progressive metastatic pulmonary calcification after successful renal transplantation

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Progressive metastatic pulmonary calcification after successful renal transplantation

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