There is a broad differential diagnosis for intrathoracic calcifications. In order to narrow down the list, one must assess (1) the location (parenchymal, pleural-based, mediastinal or chest wall) and (2) if parenchymal, whether they are focal or diffuse. 

In this particular case, intraparenchymal parasitic etiology was initially considered based on the intrathoracic calcifications but over the years, the patient developed symmetrical soft tissue dystrophic calcifications in the bilateral upper and lower limbs. FDG-PET suggested active disease at the sites of calcinosis without signs of malignancy. The patient finally underwent a skin biopsy confirming dermatomyositis.

Case contributed by Dr Josephine Pressacco.