Contributed by Kate M. Serdy, MD and Sanja Dacic, MD, PhD
The patient is a woman in her seventies who began experiencing exertional dyspnea ten years ago. Since her initial presentation, her dyspnea has become progressively more severe, with supplemental oxygen requirements reaching 12 liters at rest and up to 18 liters with activity. She is admitted for a double lung transplant.
A chest radiograph showed diffuse micronodularity, some of which is calcified, involving all lobes of both lungs (Figure 1)
CT showed diffuse ground glass airspace opacity with nodular interstitial thickening and diffuse punctate parenchymal calcifications (Figure 2).
Both lungs were heavy (right: 1401g, left: 1108g) and showed red-tan, rock-hard parenchyma with diffuse grittiness (Figures 3 and 4). Calcifications were most prominent basally and around hilum. Lymph nodes were normal in size.
Histologic examination showed intraalveolar numerous lamellated calcifications. The alveolar septa showed fibrosis. Foci of metaplastic ossification were also seen (Figures 5, 6, 7).