British Journal of Radiology 75 (2002),711-712 © 2002 The British Institute of Radiology
Regarding metastatic pulmonary calcification in renal failure
The Editor—Sir,
I read with interest the article by Lingam et al onmetastatic pulmonary calcification (MPC) in patients with end-stage renal failure (ESRF) [1]. The authors described the imaging findings of MPC in a 56-year-old male with ESRF, and recommended the use of high resolution CT as aneffective method to detect the presence of pulmonary calcification. However, they omitted to refer to two other important techniques that can be used in the assessment of MPC. Dual energy digital chest radiography has been reported to be sensitive in demonstrating MPC compared with standard plain chest radiography, which, as the authors indicated, is insensitive in detecting a small amount of pulmonary calcification [2]. Advanced MPC can be easily recognized on the standard chest radiograph but it should be differentiated from other causes of pulmonary calcification, particularly previous tuberculous infection (Figure 1
). It was surprising that the authors did not include tuberculosis in their differential diagnosis of the causes of multifocal pulmonary parenchymal calcification. The other useful technique in detecting early MPC is isotope imaging using hydroxymethylene diphosphonate (HDP) employing the standard technique used inisotope bone scanning. Uptake of the isotope inthe lungs will be seen in patients with MPC (Figure 2). This is probably the most sensitive technique in detecting early MPC. However, studies on the use of this technique in the evaluation of MPC in patients with ESRF are lacking.
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Figure 1. A standard chest radiograph showing extensive calcification in the right upper zone and mild nodular calcification in the left upper zone owing to metastatic pulmonary calcification in a patient with end-stage renal failure and secondary hyperparathyroidism. There was no history of previous tuberculous infection.
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Figure 2. Frontal view of the chest of a patient withend-stage renal failure and secondary hyperparathyroidism during isotope bone scanning using hydroxymethylene diphosphonate (HDP) to investigate musculosketal pain. High uptake of the isotope is seen in the lungs owing to metastatic pulmonary calcification. The chest radiograph was normal.
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The authors also omitted to mention that metastatic pleural calcification may also be observed inpatients with ESRF [3]. A case ofmetastatic pleural calcification in a patient with ESRF and secondary hyperparathyroidism from our institute is presented (Figure 3). The patient denied any exposure to asbestos in the past.
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Figure 3. A standard chest radiograph of a patient with end-stage renal failure and secondary hyperparathyroidism showing pleural calcification in the left mid zone and along the left hemidiaphragm. The patient denied a history of asbestos exposure.
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Finally, the authors are to be congratulated in bringing to the attention of readers of the British Journal of Radiology this important but not widely recognized complication of ESRF that may cause impairment of gas exchange and pulmonary fibrosis.
Yours etc.,
S K Morcos
Department of Diagnostic Imaging, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
Received for publication March 21, 2002.
Accepted for publication April 12, 2002.
References
- Lingam RK, Teh J, Sharma A, Friedman E. Metastatic pulmonary calcification in renal failure: a new HRCT pattern. Br J Radiol 2002;75:74–7.[Abstract/Free Full Text]
- Sanders T. Dual-energy DSA reveals elevated levels of calcium. Diagnostic Imaging International, February 1988.
- Watanabe T, Kobayashi T. Pleural calcification: a type of metastatic calcification in chronic renal failure. Br J Radiol 1983;56:93–8.[Abstract]
Related articles in BJR:
- Authors' reply
- R K Lingam and E P Friedman
BJR 2002 75: 712.
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