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Coumadin-Induced Tracheobronchial Calcification

Imaging findings

Chest radiograph demonstrates extensive, dense calcification of the cartilaginous rings of the trachea and proximal bronchi. A classic caged-ball prosthetic aortic valve (Star-Edwards valve) is also visible.

Key takeaways

Long-term warfarin (Coumadin) therapy can lead to extensive calcification of the tracheobronchial cartilages. Warfarin inhibits vitamin K, which is required for the activation of matrix Gla protein, a potent inhibitor of tissue calcification. When this protein is inactive, calcium precipitates into cartilaginous structures.

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