CTICasesUnusual Bilateral Pleural Calcifications in a Young Man — Milk of Calcium
Imaging findings
CT in a young man from El Salvador demonstrates unusual bilateral pleural deposits including a large lenticular calcified mass on the left basal hemithorax, smaller deposits along the right hemi-diaphragm and posterior pleura, and a deposit along the upper left mediastinum. The lung parenchyma is not disturbed and there is no significant pleural thickening. There are two distinct types of calcification: amorphous anterior milk-of-calcium type and denser punctate posterior calcification forming a lenticular shape together. A calcified granuloma is present in the left lower lobe and a small calcified mediastinal node. History is notable for prior remote tuberculosis and drug abuse.
Key takeaways
Unusual pleural calcifications in a young patient without asbestos exposure should raise consideration of prior pleural inflammation with milk of calcium formation or other rare entities. Two distinct forms of calcification within a single lenticular pleural deposit — amorphous low-density calcium anteriorly and dense punctate calcium peripherally — is a distinctive pattern for milk of calcium collections. The smooth pleural interface without lung bands or significant thickening favors a collection (fluid-derived) rather than pleural plaque (fibrosis-derived) origin. Tropical disease and prior pleural infections should be investigated in young immigrants from endemic regions.
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