Pulmonary Alveolar Septal Calcinosis Causing Progressive Respiratory Failure in Acute Lymphoblastic Leukemia in Childhood

Abstract

A syndrome of pulmonary alveolar septal calcinosis, pneumothorax, and pneumomediastinum, leading to rapidly progressive acute respiratory insufficiency and death was observed in 2 children with acute lymphoblastic leukemia (ALL). Primary clinical and radiological considerations in these patients were pulmonary edema and infection, and the diagnosis of pulmonary alveolar septal calcification was established only at autopsy. One patient, a 15-year-old girl, was found also to have parathyroid hyperplasia typical of familial hyperparathyroidism. The other, a 16-month-old girl, showed osteitis fibrosa of the bones and parathyroid hyperplasia of secondary type, suggesting that the pulmonary calcinosis resulted from hypercalcemia caused by a parathormone or prostaglandin-secreting tumor. The cause of pneumothorax and pneumomediastinum may have been rupture of calcified alveolar septa induced by high PEEP during ventilation of these patients. Other possible mechanisms contributing to hypercalcemia and pulmonary calcinosis in children with acute leukemia include bone resorption due to marrow infiltration, immobilization syndrome, renal failure, and administration of calcium, phosphate, or bicarbonate. This complication of acute leukemia in childhood is rare (2 patients in 430 autopsied over the period 1961-1982 at Childrens Hospital of Los Angeles). How often the process can be reversed if diagnosed before severe respiratory insufficiency is present is not known.

Metastatic pulmonary calcification with ossification in a child with acute lymphoblastic leukemia

“…4 It is rare in leukemia, although several cases have been described, 2,5-9 some of them in children under 17 years of age. 2,[5][6][7] In some cases of leukemia-associated hypercalcemia, hypercalcemia was evident at the very beginning of the disease, and it did not recur subsequently during the course of the illness. 7 This was the case in our patient who presented with hypercalcemia, polydipsia, and polyuria.…”

Thoracic Calcifications in Childhood

“…26 Pulmonary alveolar septal calcinosis has also been described. 27 Pulmonary calcinosis with diffuse fine nodular calcifications has been reported with cyanotic congenital heart disease and renal failure. 28 Metastatic pulmonary calcifications occurring in patients with chronic renal failure are one cause of diffuse or focal parenchymal calcification best depicted by CT.…”