CTICasesMilk of Calcium Pleural Collections
Imaging findings
CT in a young man from El Salvador with prior pleural effusions demonstrates bilateral lenticular calcified deposits along the pleural surfaces, including a large one along the left lateral pleura and smaller ones along the right hemidiaphragm and posterior pleura. On closer inspection there are two different types of calcification: more amorphous lower-attenuation milk-of-calcium type material anteriorly and denser punctate calcification peripherally. The lung parenchyma is relatively unperturbed without significant pleural thickening. This follow-up report updates a prior conference case where Howard's observation of two types of calcification led to a literature search that yielded a Korean case series on milk of calcium pleural collections from prior pleural inflammation.
Key takeaways
Milk of calcium pleural collections can develop as residua of prior pleural inflammation including empyema. The CT appearance includes lenticular or elliptical calcified deposits along the pleural surfaces with an inner, more amorphous low-attenuation calcium (milk of calcium) and a denser peripheral rim of calcification, and may demonstrate a fluid level on certain projections. In a young patient without asbestos exposure, milk of calcium from prior pleural effusion or infection is a more likely explanation for smooth calcified pleural deposits than early-onset asbestos-related pleural plaques. The relative lack of significant pleural thickening and the smooth interface with the lung help distinguish this from post-inflammatory pleural thickening or talcosis.
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