CTICasesDendriform Pulmonary Ossification
Imaging findings
An asymptomatic man in his 60s undergoing CT urography for hematuria has incidental linear, branching, clustered calcifications following the pulmonary interstitium in a perilymphatic-like distribution, more prominent toward the lung bases, with only a tiny focus of bronchiectasis and no other fibrosis. He has never had respiratory symptoms.
Key takeaways
Dendriform pulmonary ossification appears as branching linear calcifications within the interstitium, thought to arise when interstitial fibroblasts in a hypoxic or acidic environment transform into osteoblasts and produce bone. It is classically associated with UIP but can occur without it (including with recurrent acid aspiration), can be exuberant, is benign, and should be left alone; it is also one recognized pattern of amyloid, which a biopsy could distinguish if ever desired, though none is needed.
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