Dendriform pulmonary ossification

Case contributed by Dr Franco A. Scola

Presentation

Presented to ED with dyspnoea, cough and weakness in the last 7 days. Ex-smoker.

Patient Data

Age: 65
Gender: Female
X-ray

Reticulonodular densities in right upper lobe.

Area of consolidation near to left hilum.

Bilateral pleural effusions.

*film artifact observed next to the right cardiac margin.

Hyperdense linear opacities located in right upper lobe, basal segments of right inferior lobe and left inferior lobe, suggestive of dendriform pulmonary ossification.

Large hydropneumothorax in left hemithorax, with a total collapse of the left inferior lobe. Consolidation in anterior segment of left upper lobe.

Atelectasis involving right inferior lobe caused by moderate pleural effusion. Opacity of aerated portion of this lobe suggests consolidation.

Diffuse left pleural thickening.

Mediastinal lymphadenopathy.

Total left mastectomy and right segmental mastectomy.

Case Discussion

Diffuse pulmonary ossification (DPO) is a rare asymptomatic condition characterized by presence of mature bone in the interstitial or alveolar spaces.

Dendriform is one of the two forms of presentation of DPO, and usually occurs in men, around sixth decade of life. Pathogenesis has not yet been elucidated, but some factors, such as amyloidosis, busulfan (chemotherapy), asbestos exposure, and cystic fibrosis, have been linked.

This patient had a mastectomy due to a breast cancer seventeen years ago, with adjuvant chemoradiotherapy. The treatment was not performed in the same hospital as these scans, so treatment details were not available.

Following antibiotic therapy she was discharged from hospital. No histological study was made to confirm DPO.

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Case information

rID: 37198
Case created: 28th May 2015
Last edited: 8th May 2017
System: Chest
Inclusion in quiz mode: Included

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