CTICasesDiffuse Pulmonary Ossification (Dendriform Type)
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Imaging findings
The chest X-ray showed diffuse, bilateral, dense interstitial infiltrates with calcium density, consistent with pulmonary hypertension. The CT scan confirmed these findings, showing changes of chronic pulmonary emboli, with narrowing and irregularity of the pulmonary arterial lumens bilaterally. Dense, reticular, branching calcifications were seen throughout the lungs, most predominant and exuberant in the bases. Despite the calcifications, lung windows showed normal airway caliber, some bronchial thickening, but no significant fibrosis, bronchiectasis, honeycombing, or architectural distortion in the lung parenchyma between the calcifications. The patient also had a dilated right atrium and hepatic veins.
Key takeaways
This is a severe case of diffuse pulmonary ossification, specifically the dendriform type, which is typically a secondary process associated with chronic pulmonary hypertension, fibrosis, or chronic edema. Patients generally do well, with the ossification being a secondary finding. The calcification can progress slowly over many years. The calcification appears interstitial rather than alveolar microlithiasis. It's unclear if chronic warfarin/coumadin use could contribute to such extensive calcification.
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