Metastatic pulmonary calcification in end-stage kidney disease presenting as extensive bilateral pulmonary infiltrates with minimal respiratory symptoms: A case report

Abstract

Author(s): Tan Quoc Nguyen, Ngoc Nga Truong Thi, Van Hai Nguyen*, Minh Thuy Doan and Huong Giang Pham Thi

Background: Metastatic pulmonary calcification (MPC) is an uncommon but under-recognized complication of end-stage kidney disease. Because chest radiography often shows diffuse bilateral pulmonary opacities, MPC may be mistaken for pulmonary oedema, infection, miliary tuberculosis, or malignancy, especially when the radiological abnormalities appear extensive. Case Report: A 62-year-old man with stage 5 chronic kidney disease on maintenance haemodialysis three times weekly underwent routine chest imaging. He had no cough, dyspnoea, chest pain, or fever, and oxygen saturation on room air was 98%. Serial chest radiographs over 16 months demonstrated persistent and slowly progressive diffuse bilateral pulmonary infiltrates. Chest computed tomography revealed diffuse ground-glass opacities, centrilobular ground-glass nodules with punctate high-attenuation foci in both lungs, and widespread vascular and soft-tissue calcifications with diffuse skeletal sclerosis. No thoracoabdominal lymphadenopathy or primary malignancy was identified. Acid-fast bacilli smear was negative. Arterial blood gas analysis showed preserved oxygenation with metabolic alkalosis, explaining the absence of respiratory symptoms despite marked imaging abnormalities. The combination of chronic kidney failure, haemodialysis, characteristic CT findings, systemic calcification, and clinicoradiological dissociation supported the diagnosis of MPC. Conclusion: MPC should be considered in patients with end-stage kidney disease who present with extensive bilateral pulmonary opacities that are disproportionate to their mild or absent respiratory symptoms. Chest CT plays a key role in identifying characteristic calcific pulmonary lesions and avoiding misdiagnosis and unnecessary treatment.

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