Diffuse pulmonary ossification–a rare complication of tuberculosis

Chow, Louis T. C.; Shum, Bobby S.F.; Chow, Wing‐Hing; Tso, Chi-Yin

doi:10.1111/j.1365-2559.1992.tb01016.x

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…This patient also had concomitant COPD and severe fibrosis and bronchiectasis. A second case of diffuse pulmonary ossification in the alveolar septa associated with caseating granulomas was reported in a patient that had developed TB and was [4]. In the case we describe here, the observed bony metaplasia was a focal spot in the cartilage limited to a severely inflamed bronchus.…”

Section: Discussionmentioning

confidence: 62%

Metaplastic ossification in the cartilage of the bronchus of a patient with chronic multi-drug resistant tuberculosis: a case report

et al. 2010

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IntroductionPulmonary ossification has been rarely observed in pulmonary fibrosis and in some chronic respiratory diseases such as chronic obstructive pulmonary disease. We report here a metaplastic ossification in the bronchial cartilage of a patient with multi-drug resistant tuberculosis.Case presentationWe report the case of a 41-year-old Asian man from Korea with chronic multi-drug resistant tuberculosis with a rare focus of bone formation from the cartilage of a bronchus subtending an active cavity. The patient had a large multi-lobed, thick-walled cavitary tuberculosis lesion in his left upper lobe. Severe infiltration of his lymphocytes and epithelioid cells, along with some giant cells and neutrophils, was observed in the patient's bronchial wall. Desquamated bronchial epithelium and acid-fast bacilli were found inside his bronchus. A small focus of bony metaplasia was found in the cartilage of his bronchial wall. Histopathological examination confirmed calcification and showed hematopoietic cells forming in his marrow cavity.ConclusionsChronic inflammation in the lungs of our patient, caused by underlying tuberculosis, probably played a role in the development of osseous metaplasia from the associated cartilage of the bronchial wall.

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Section: Discussionmentioning

confidence: 62%

Metaplastic ossification in the cartilage of the bronchus of a patient with chronic multi-drug resistant tuberculosis: a case report

et al. 2010

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“…Most of the cases reported are associated with chronic inflammation, such as organizing interstitial pneumonia. (9) The histopathological type described herein is the dendriform pulmonary ossification one, also known as: pulmonary osteopathy, idiopathic disseminated pulmonary ossification, ossifying pneumonitis, bone metaplasia of the lung, racemose or reticular osteoplastic pulmonary disease, and arboriform ossification. (4,10) Dendriform pulmonary ossification is found associated with several conditions, such as histoplasmosis, chronic therapy with busulfan, pulmonary metastases of osteogenic sarcoma, pulmonary amyloidosis, areas of dystrophic calcifications, (1,11) and Goodpasture's syndrome.…”

Section: Discussionmentioning

confidence: 98%

“…The cause most frequently implicated is chronic pulmonary inflammation, (9,12) which some authors consider to be a special form of idiopathic pulmonary fibrosis. (12) Other conditions less frequently associated are interstitial pneumonia, lung abscess, (13) myositis ossificans, cystic fibrosis, hemodialysis, diabetes mellitus, acromegaly, gastric adenocarcinoma, and melanoma.…”

Section: Discussionmentioning

confidence: 99%

Ossificação pulmonar dendriforme

et al. 2006

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Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

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“…118,119 Diffuse parenchymal calcification with possible accompanying ossification mainly occurs in diseases with abnormal calcium/phosphorus metabolism, such as hyperparathyroidism (both primary and secondary, especially in patients with chronic renal failure on periodic hemodyalisis), hypervitaminosis D and milk-alkali syndrome, infectious granulomatous disorders, including fungal and parasitic diseases, pneumoconiosis, alveolar proteinosis, and pulmonary alveolar microlithiasis. 1,89,116,117,[120][121][122][123][124][125] Intraoperatively or in video-assisted thoracoscopy, the irregular lung surface because of the DPO has sometimes been rightly analogized to a coral-reef appearance 64 or to a balloon bound with wire nettings. 71 The histologic diagnosis of diffuse pulmonary ossification is straightforward, and the differential diagnosis between the 2 main forms (dendriform vs. nodular) is based either on the branching appearance of spicules, the presence of fatty or hematopoietic marrow within the intertrabecular spaces, or the presence of fibrous tissue surrounding bone in the interstitium, which are typically seen in DPO and usually absent in the nodular form.…”

Section: Authors' Commentmentioning

confidence: 99%

Selected Case From the Arkadi M. Rywlin International Pathology Slide Series

Bisceglia¹,

Chiaramonte

Panniello

et al. 2015

Advances in Anatomic Pathology

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Two cases of diffuse dendriform pulmonary ossification (DPO) are presented, one of the secondary type and the other of the idiopathic type. Case 1 was an adult female patient who underwent thoracic surgery to remove a posterior mediastinal bronchogenic cyst, which was discovered on a computed tomography scan performed after an episode of pneumonia when traction bronchiectasis with interstitial lung disease/fibrosis was also suspected in the lungs. Histologic examination performed on the resected lung tissue revealed numerous scattered small osseous spicules on a background of intense interstitial inflammation and fibrosis, leading to further clinical and laboratory investigations and the final diagnosis of DPO secondary to lung involvement by scleroderma. Case 2 was an adult male patient who underwent thoracoscopic exploration after a computed tomography scan, which revealed traction bronchiectasis with linear thickening of the interstitial lung tissue. Histologic examination of the lung tissue specimen revealed numerous osseous spicules in the absence of interstitial septal inflammation. Noteworthy in this case were also some nodules of collagenized tissue similar to those seen in the lungs of patients affected by Ehlers-Danlos syndrome. The absence of any clinical sign or symptoms related to Ehlers-Danlos syndrome attest to the nonspecificity of these pulmonary fibrous nodules. No case of DPO secondary to scleroderma has been reported in the literature so far, although around half of the patients with scleroderma manifest pulmonary diseases. Idiopathic DPO is even rarer, usually discovered postmortem, with only 20 cases diagnosed in life with lung biopsies taken by open surgery or through a thoracoscopic approach. DPO is often misdiagnosed radiologically as bronchiectasis and/or interstitial lung disease/fibrosis.

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Diffuse pulmonary ossification–a rare complication of tuberculosis

Cited by 15 publications

References 4 publications

Metaplastic ossification in the cartilage of the bronchus of a patient with chronic multi-drug resistant tuberculosis: a case report

Metaplastic ossification in the cartilage of the bronchus of a patient with chronic multi-drug resistant tuberculosis: a case report

Ossificação pulmonar dendriforme

Selected Case From the Arkadi M. Rywlin International Pathology Slide Series

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