CTICasesDendriform Pulmonary Ossification
Imaging findings
A 25-year-old with subacute dyspnea has bilateral small, discrete, dense nodules of calcium attenuation, many along the bronchovascular bundles but also abutting the fissures and pleural surfaces, without lymphadenopathy and with little underlying fibrosis. Transbronchial biopsy showed intra-alveolar (dendriform) pulmonary ossification, with some of the ossification appearing to extend into lymphatics and beyond the air spaces.
Key takeaways
Dendriform pulmonary ossification presents as branching or nodular ossific densities, classically lower-lobe and associated with fibrosis or chronic aspiration but here idiopathic in an unusually young patient with normal intervening parenchyma. It is generally a benign, incidental entity that does not warrant biopsy, though amyloidosis and alveolar microlithiasis are considered in the differential, and unusual features (young age, extension along fissures/pleura) prompted debate about a larger surgical biopsy.
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