Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease
A 65-year-old male complaining of low back pain was noted to have diffuse, homogenous bilateral lung uptake on Tc-99m methylene diphosphate (Tc99m-MDP) bone scintigraphy. The patient had no prior history of pulmonary disease with no apparent respiratory symptoms at time of imaging, but did endorse a...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043323005587 |
| _version_ | 1797672106400415744 |
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| author | Nina H. Cheng, MS Yi Li, MD Gang Cheng, MD, PhD |
| author_facet | Nina H. Cheng, MS Yi Li, MD Gang Cheng, MD, PhD |
| author_sort | Nina H. Cheng, MS |
| collection | DOAJ |
| description | A 65-year-old male complaining of low back pain was noted to have diffuse, homogenous bilateral lung uptake on Tc-99m methylene diphosphate (Tc99m-MDP) bone scintigraphy. The patient had no prior history of pulmonary disease with no apparent respiratory symptoms at time of imaging, but did endorse a long history of lupus nephritis and end-stage renal disease on hemodialysis. Review of prior chest CT and chest X-ray imaging over the last 5 years revealed diffuse ground-glass opacities and extensive parenchymal calcifications, consistent with metastatic pulmonary calcification. These radiological findings were further corroborated by laboratory studies, which demonstrated longstanding secondary hyperparathyroidism with a most recent work-up including an iPTH level of 1251 pg/mL. The differential diagnosis of bilateral, diffuse Tc99m-MDP uptake on bone scintigraphy includes tracer contamination, pulmonary etiologies such as pleural effusion or mesothelioma, metabolic diseases such as metastatic pulmonary calcification, and genetic diseases including pulmonary alveolar microlithiasis. In the setting of longstanding renal dysfunction and chronic hypercalcemia as in this patient, such radiological findings are a classic presentation of metastatic pulmonary calcification. |
| first_indexed | 2024-03-11T21:25:15Z |
| format | Article |
| id | doaj.art-cf91c7eb6c1b44579cecf7baa6b5787f |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-03-11T21:25:15Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-cf91c7eb6c1b44579cecf7baa6b5787f2023-09-28T05:25:23ZengElsevierRadiology Case Reports1930-04332023-11-01181139933996Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal diseaseNina H. Cheng, MS0Yi Li, MD1Gang Cheng, MD, PhD2Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia PA 19129, USADepartment of Radiology, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA 19111, USADepartment of Radiology, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Corresponding author.A 65-year-old male complaining of low back pain was noted to have diffuse, homogenous bilateral lung uptake on Tc-99m methylene diphosphate (Tc99m-MDP) bone scintigraphy. The patient had no prior history of pulmonary disease with no apparent respiratory symptoms at time of imaging, but did endorse a long history of lupus nephritis and end-stage renal disease on hemodialysis. Review of prior chest CT and chest X-ray imaging over the last 5 years revealed diffuse ground-glass opacities and extensive parenchymal calcifications, consistent with metastatic pulmonary calcification. These radiological findings were further corroborated by laboratory studies, which demonstrated longstanding secondary hyperparathyroidism with a most recent work-up including an iPTH level of 1251 pg/mL. The differential diagnosis of bilateral, diffuse Tc99m-MDP uptake on bone scintigraphy includes tracer contamination, pulmonary etiologies such as pleural effusion or mesothelioma, metabolic diseases such as metastatic pulmonary calcification, and genetic diseases including pulmonary alveolar microlithiasis. In the setting of longstanding renal dysfunction and chronic hypercalcemia as in this patient, such radiological findings are a classic presentation of metastatic pulmonary calcification.http://www.sciencedirect.com/science/article/pii/S1930043323005587Metastatic pulmonary calcificationBone scanBone scintigraphyTc-99m methylene diphosphateLung uptake |
| spellingShingle | Nina H. Cheng, MS Yi Li, MD Gang Cheng, MD, PhD Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease Radiology Case Reports Metastatic pulmonary calcification Bone scan Bone scintigraphy Tc-99m methylene diphosphate Lung uptake |
| title | Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease |
| title_full | Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease |
| title_fullStr | Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease |
| title_full_unstemmed | Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease |
| title_short | Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease |
| title_sort | metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end stage renal disease |
| topic | Metastatic pulmonary calcification Bone scan Bone scintigraphy Tc-99m methylene diphosphate Lung uptake |
| url | http://www.sciencedirect.com/science/article/pii/S1930043323005587 |
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