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Metastatic pulmonary calcinosis
Calcinosis pulmonar metástasica
Raquel Montoiro Alluéa, Alfonso Perez Trullenb, Silvia Moreno Loshuertosc
a Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Zaragoza, España,
b Servicio de Neumología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Zaragoza, España,
c Servicio de Nefrología, Hospital Santa Bárbara, Soria, Soria, España,
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    "textoCompleto" => "To the editor&#58; Metastatic pulmonary calcinosis &#40;MPC&#41; is an uncommon process of unknown etiology associated to a wide variety of both benign and malignant conditions&#46; Pathophysiologically&#44; MPC consists of calcium deposition in the epithelial and vascular basement membrane of alveoli&#44; bronchial walls&#44; and media layer of pulmonary arteries&#44; resulting in a lymphoproliferative interstitial response and pulmonary fibrosis&#46; The significance of early diagnosis of this complication lies in the fact that pulmonary calcifications&#44; in this particular condition&#44; may be potentially reversible with adequate&#44; early treatment&#46; <br></br><br></br>We report the case of a 37-year-old male&#44; a former smoker with no known drug allergies and a history of kidney <br></br>transplant for chronic renal failure &#40;CRF&#41; secondary to membranoproliferative glomerulonephritis&#44; systemic arterial hypertension&#44; and acute myocardial infarction&#46; Routine chest Xrays of the patient showed an alveolarinterstitial pattern in both upper lobes&#44; predominately on the left side&#44; with no respiratory symptoms&#44; and was therefore admitted to hospital for diagnostic work-up&#46; Blood and chemistry laboratory test results included&#58; hemoglobin 6&#46;9 g&#47;dL&#44; hematocrit 20&#46;9&#37;&#44; WBCs 9&#46;500&#47;mm3 with normal differential count&#44; platelet count 195&#44;000&#47;mm3&#44; ESR 135 mm&#44; iron metabolism and coagulation study within normal limits&#44; except for fibrinogen increase to 766 mg&#47;dL&#46; Basal glucose 86 mg&#47;dL&#44; creatinine 8&#46;6 mg&#47;dL&#44; urea 119 mg&#47;dL&#44; sodium 138 mEq&#47;L&#44; potassium 4&#46;3 mEq&#47;L&#44; chloride 100 mEq&#47;L&#44; calcium 9&#46;23 mg&#47;dL&#44; phosphorus 7&#46;83 mg&#47;dL&#44; parathormone 2&#44;475 pg&#47;mL&#44; normal TSH&#44; C-reactive protein 1&#46;65 mg&#47;dL&#44; beta-2-microglobulin 20&#46;80 mcg&#47;mL&#44; lipid profile&#44; proteinogram&#44; and liver function within normal ranges&#46; Diagnostic tests included a high-resolution CT scan &#40;fig&#46; 1&#41; that showed highdensity bilateral involvement of middle and upper pulmonary fields consistent with calcifications&#46; Radiographic bone series revealed advanced vascular calcifications&#46; Functional respiratory test results included&#58; forced vital capacity &#40;FVC&#41;&#44; 4&#46;22 L &#40;81&#46;2 &#37; of <br></br>predicted&#41;&#59; forced expiratory volume in the first second &#40;FEV1&#41;&#44; 3&#46;60 L &#40;88&#46;4 &#37; of predicted&#41;&#59; FEV1&#47;FVC&#44; 85&#46;1 &#37;&#59; RV&#44; 2&#46;04 L &#40;109&#46;4 &#37; of predicted&#41;&#59; TLC&#44; 6&#46;23 &#40;91&#46;2 &#37; of predicted&#41;&#46; CO diffusion was moderately decreased in absolute values&#44; partially corrected with AV measured&#44; suggesting loss of alveolar units for exchange&#46; Bronchoscopy visualized a bronchial tree with whitish images of a hard consistency&#44; linear and parallel to each other and diffusely distributed in both lungs&#44; consistent with metastatic calcifications&#46; BAL and transbronchial pulmonary biopsy were performed and confirmed diagnosis&#46; <br></br><br></br>In 1855&#44; Virchow first described metastatic pulmonary calcinosis&#46; This is usually associated to changes in calcium and phosphorus metabolism and to systemic and local pH&#46; The most common cause of metastatic calcifications is chronic renal failure&#44; and other less common causes include primary and secondary hyperparathyroidism&#44; kidney transplant&#44; osteopetrosis&#44; hypervitaminosis D&#44; and malignant diseases such as multiple myeloma&#44; leukemia&#44; <br></br>parathyroid carcinoma&#44; and others&#46; A high prevalence &#40;up to 60&#37;-80&#37; in certain series&#41; is found in patients with chronic renal failure undergoing hemodialysis&#46; Chest X-rays are poorly sensitive for diagnosis of this condition&#44; while the greater sensitivity of high-resolution CT allows for detecting small calcifications&#46; Clinical course is usually silent&#44; and most patients remain asymptomatic&#44; as occurred in the onereported here&#46; If calcium deposits are extensive&#44; a decreased diffusion&#44; a restrictive functional pattern&#44; and hypoxemia may be seen&#46; Pulmonary fibrosis may occur in most severe cases&#44; leading to respiratory insufficiency and even death&#46; "
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        "resumen" => "La calcinosis pulmonar metast&#225;sica &#40;CPM&#41; es un proceso infrecuente&#44; de etiolog&#237;a desconocida&#44; asociada a una amplia variedad de procesos tanto benignos como malignos&#46; Cuya implicaci&#243;n fisiopatol&#243;gica es el dep&#243;sito de calcio en la membrana basal epitelial y vascular del alveolo&#44; paredes bronquiales y capa media de las arterias pulmonares&#46; Dando lugar a una repuesta intersticial linfoproliferativa y fibrosis pulmonar&#46; La importancia de diagnosticar de forma precoz esta complicaci&#243;n radica en que las calcificaciones pulmonares&#44; en este tipo de alteraci&#243;n en concreto&#44; pueden ser potencialmente reversibles con un tratamiento adecuado y precoz&#46;"
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Article information
ISSN: 20132514
Original language: English
DOI:
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Idiomas
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