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Case of the winter season
Case of the Winter
Season
Edito C. Cabal, M.D.
T
HIS 38-year-old white man was discovered to have polyposis of the colon at the ageof 17, for which a total colectomy wasperformed. During recent years he had had chronic diarrhea. Multiple
Edito C. Cabal, M.D.: Assistant Professor of Radiology, School of Medicine, St. Louis University, St. Louis, MO. Reprint requests should be addressed to Edit0 C. Cabal, M.D., Department of Radiology, John Cochran Veterans Administration Hospital, St. Louis, MO. 63125. 01976 by Grune & Stratton, Inc.
Fig.
Seminars
in Roenrgenology,
1.
Vol.
hospitalizations were required for electrolyte deficiency, dehydration, malnutrition, and anemia. He was hyponatremic and hypokalemic. Serum calcium rangedfrom 8 to 10 mg/ 100 ml and serum phosphorus from 7 to 10.85 mg/lOO ml. He had azotemia with BUN ranging from 42 to 102 mg/ 100 ml and serumcreatinine from 5.9 to 6.2 mg/ 100 ml. A left renal biopsy revealedchangescompatible with hypokalemic nephropathy. He developed progressivedyspnea, and died, apparently of cardiac arrest. Figures 1 and 2 were obtained on the final admission.
Fig. 2.
Xl,
No.
1 (January),
1976
15
16
EDIT0
C.
CABAL
Fig. 3.
DIAGNOSIS: SECONDARY HYPERPARATHYROIDISM WITH EXTENSIVE “METASTATIC” PULMONARY CALCIFICATIONS
The chest radiographs(Figs. 1 and 2) show very densecalcific infiltrates in the central pulmonary areaswith the periphery relatively clear. Postmortem examination revealed four enlarged hyperplastic parathyroid glands.The lungsfelt like bagsfilled with fine gravel. Cut sectionsfelt gutty and confirmed the butterfly distribution of the calcific infiltrate. Microscopic examination revealed massesof calcium of varying sizesin the alveolar septa (Fig. 3). Calcium depositionswere also seen in the kidneys and aortic and mitral valves. There was marked tubular atrophy of the kidneys and areas of glomerular sclerosis.The bonesshowedgeneralizedosteitis fibrosa. “Metastatic” pulmonary calcification has been describedin chronic renal failure, excessiveingestion or parenteral administration of calcium salts, hypervitaminosis D, excessive bone destructive
process, sarcoidosis, and hyperfunction of the parathyroids.’ J Usually the pulmonary calcification is of diffuse punctate pattern; however, segmentalor confluent areasmay be seen,asin this patient. Dense,evenly distributed calcifications throughout both lungs can be seenin pulmonary microlithiasis, but microscopically the calcium depositions are within the alveolar sacs.3 Nodular pulmonary calcifications may also be seen as a sequela of varicella infection and in histoplasmosis. REFERENCES 1. McLachlan MSF, Wallace M, Seneviratne C: Pulmonary calcification in renal failure. Report of three cases. Br J Radio1 41:99-106, 1968 2. Kaltreider HB, Baum GL, Bogaty G, et al: So-called “metastatic” calcification of the lung. Am J Med 46: 18% 196,1969 3. Sosman MC, Dodd GD, Jones WD, et al: The familial occurrence of pulmonary alveolar microlithiasis. Am J Roentgen01 77:947-1012,1957
Season
Edito C. Cabal, M.D.
T
HIS 38-year-old white man was discovered to have polyposis of the colon at the ageof 17, for which a total colectomy wasperformed. During recent years he had had chronic diarrhea. Multiple
Edito C. Cabal, M.D.: Assistant Professor of Radiology, School of Medicine, St. Louis University, St. Louis, MO. Reprint requests should be addressed to Edit0 C. Cabal, M.D., Department of Radiology, John Cochran Veterans Administration Hospital, St. Louis, MO. 63125. 01976 by Grune & Stratton, Inc.
Fig.
Seminars
in Roenrgenology,
1.
Vol.
hospitalizations were required for electrolyte deficiency, dehydration, malnutrition, and anemia. He was hyponatremic and hypokalemic. Serum calcium rangedfrom 8 to 10 mg/ 100 ml and serum phosphorus from 7 to 10.85 mg/lOO ml. He had azotemia with BUN ranging from 42 to 102 mg/ 100 ml and serumcreatinine from 5.9 to 6.2 mg/ 100 ml. A left renal biopsy revealedchangescompatible with hypokalemic nephropathy. He developed progressivedyspnea, and died, apparently of cardiac arrest. Figures 1 and 2 were obtained on the final admission.
Fig. 2.
Xl,
No.
1 (January),
1976
15
16
EDIT0
C.
CABAL
Fig. 3.
DIAGNOSIS: SECONDARY HYPERPARATHYROIDISM WITH EXTENSIVE “METASTATIC” PULMONARY CALCIFICATIONS
The chest radiographs(Figs. 1 and 2) show very densecalcific infiltrates in the central pulmonary areaswith the periphery relatively clear. Postmortem examination revealed four enlarged hyperplastic parathyroid glands.The lungsfelt like bagsfilled with fine gravel. Cut sectionsfelt gutty and confirmed the butterfly distribution of the calcific infiltrate. Microscopic examination revealed massesof calcium of varying sizesin the alveolar septa (Fig. 3). Calcium depositionswere also seen in the kidneys and aortic and mitral valves. There was marked tubular atrophy of the kidneys and areas of glomerular sclerosis.The bonesshowedgeneralizedosteitis fibrosa. “Metastatic” pulmonary calcification has been describedin chronic renal failure, excessiveingestion or parenteral administration of calcium salts, hypervitaminosis D, excessive bone destructive
process, sarcoidosis, and hyperfunction of the parathyroids.’ J Usually the pulmonary calcification is of diffuse punctate pattern; however, segmentalor confluent areasmay be seen,asin this patient. Dense,evenly distributed calcifications throughout both lungs can be seenin pulmonary microlithiasis, but microscopically the calcium depositions are within the alveolar sacs.3 Nodular pulmonary calcifications may also be seen as a sequela of varicella infection and in histoplasmosis. REFERENCES 1. McLachlan MSF, Wallace M, Seneviratne C: Pulmonary calcification in renal failure. Report of three cases. Br J Radio1 41:99-106, 1968 2. Kaltreider HB, Baum GL, Bogaty G, et al: So-called “metastatic” calcification of the lung. Am J Med 46: 18% 196,1969 3. Sosman MC, Dodd GD, Jones WD, et al: The familial occurrence of pulmonary alveolar microlithiasis. Am J Roentgen01 77:947-1012,1957