CTICasesMetastatic Pulmonary Calcification in End-Stage Renal Disease
Imaging findings
A patient with end-stage renal disease on hemodialysis and failed renal transplants has chest imaging showing bilateral, cloud-like, amorphous upper-lobe-predominant opacities that spare the interlobular septa; attenuation of the lesions is only mildly increased, less than soft tissue density, rather than frankly calcific.
Key takeaways
Bilateral cloud-like, upper-lobe-predominant opacities with septal sparing in a patient with end-stage renal disease -- sometimes described as the "photographic negative" of pulmonary edema -- represent metastatic pulmonary calcification, driven by the upper-lobe ventilation/perfusion and pH gradient that favors calcium-phosphate precipitation; the lesions can be subtle and only mildly attenuated on CT despite their striking distribution.
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