Calciphylaxis and metastatic pulmonary calcification

Case contributed by Alexandra Stanislavsky


Intravenous drug user with end-stage renal failure on long term peritoneal dialysis. She was non-compliant with her peritoneal dialysis and had poor calcium phosphate control. She presented with digital ischemia involving her right hand and both feet.

Patient Data

Age: 40 years
Gender: Female

Widespread calcified infiltrates throughout both lung fields. Right-sided intercostal catheter in situ due to recent lung biopsy. Also of note is the diffuse calcification of both brachial arteries.


Chest x-ray and HRCT demonstrate diffuse, coarse calcific pulmonary infiltrates. Also of note on the chest x-ray is the bilateral calficification of the brachial arteries.

Abdominal CT shows:

  • marked vascular calcification
  • focal splenic hypodensity consistent with a splenic infarct
  • stigmata of renal failure on peritoneal dialysis

Case Discussion


The patient's condition deteriorated and she died soon after this imaging was obtained. An autopsy was performed.

Autopsy findings: 

Evidence of calciphylaxis involving the peripheral arm vessels, aorta, splenic artery, proximal renal arteries and pumonary vessels. The right radial artery was completely thrombosed and there was distal digital ischemia. 

Further changes included wide spread pulmonary metastatic calcification.  

Renal changes were end stage.  She also had a splenic infarct and acute bronchopeunomia, with the latter being the presumed cause of death.

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