CTICasesDendriform Pulmonary Ossification
Imaging findings
Chest radiograph shows diffuse high-density material with a pattern between nodular and reticular, without significant volume loss. A follow-up CT roughly six to seven years later shows a similar, essentially unchanged pattern of diffuse ossified material predominantly in the upper lung zones and anteriorly, with only mild architectural distortion. Mild fibrosis with bronchial dilation, bronchiectasis, and ground-glass opacity is present in the lower lobes and has been stable for years. Biopsy, read out by an outside expert, confirmed exuberant dendriform pulmonary ossification with amyloid excluded.
Key takeaways
The only relevant history was a major motor vehicle collision roughly twenty years earlier with intrathoracic hemorrhage, a month-long coma, and presumed prolonged intubation, without documented renal failure. The presumed mechanism discussed was an old severe lung injury, such as an ARDS-type injury from prolonged ventilation predating lung-protective strategies, leading fibroblasts to differentiate into osteoblasts and drive progressive ossification rather than classic fibrosis, though the exact cause remains speculative. An incidental circumflex aortic arch was also noted.
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