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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 64

Metastatic calcification in end-stage renal disease: Contra naturam


Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission11-Jun-2019
Date of Web Publication25-May-2021

Correspondence Address:
Inderpaul Singh Sehgal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1982_19

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How to cite this article:
Sehgal IS, Dhooria S. Metastatic calcification in end-stage renal disease: Contra naturam. Indian J Med Res 2020;152, Suppl S1:64

How to cite this URL:
Sehgal IS, Dhooria S. Metastatic calcification in end-stage renal disease: Contra naturam. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:64. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/64/316746

The child's assent and parents' consent obtained to publish clinical information and images.


A 16 yr old male child with end-stage renal disease on maintenance haemodialysis presented in January 2019, with a history of dyspnoea and dry cough of three-month duration to the Chest Clinic of Postgraduate Institute of Medical Education & Research, Chandigarh, India.

His serum creatine was 8 mg/dl. His serum calcium and phosphorus was 11.2 mg/dl and 5.6 mg/dl, respectively. His serum parathyroid hormone level was 500 pg/ml. A computed tomography of the thorax revealed bilateral ground-glass opacification in the lung and calcification of the subcutaneous vessels [Figure 1]A and [Figure 1]B. X-ray of the upper and lower limbs also revealed calcification of the vessels [Figure 1]C and [Figure 1]D. A transbronchial lung biopsy demonstrated diffuse calcification of the lung interstitium and the vessel wall [Figure 2], confirming a diagnosis of metastatic calcification. He underwent para-thyroidectomy and was referred for renal transplantation. Pulmonary calcification is rare in end-stage renal disease. Knowledge of the radiological findings of metastatic pulmonary calcification can help in avoiding invasive procedures such as bronchoscopy.
Figure 1: High-resolution computed tomography of the thorax demonstrating (A) diffuse ground-glass opacification in the lung window and (B) multiple calcified vessels (arrowhead) in the mediastinal window. X-ray of the bilateral (C) upper and (D) lower limbs revealing arterial calcification of arteries (arrows).

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Figure 2: Haematoxylin and eosin (×200) stain of the transbronchial lung biopsy demonstrating calcification (arrow) in the interstitium and the vessel wall, confirming it to be a case of metastatic calcification.

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Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2]



 

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