Diffuse Pulmonary Ossification (DPO)
Epidemiology
History
Luschka first described DPO in 1856
Etiology
Cardiac Disease
Chronic Congestive Heart Failure (CHF) (see Congestive Heart Failure )Epidemiology : has been associated with the nodular form of diseasePhysiology : passive congestion results in extravasation of red blood cells with deposition of hemosiderin into alveolar walls -> inflammation, fibrosis, and hyalinizationHypertrophic Subaortic Stenosis (see xxxx )Epidemiology : has been associated with the nodular form of diseaseMitral Stenosis (see Mitral Stenosis )Epidemiology : has been associated with the nodular form of disease
Other
Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome )Epidemiology : has been associated with the dendriform type of diseaseAsbestosis (see Asbestos )Epidemiology : has been associated with the dendriform type of diseaseChronic Obstructive Pulmonary Disease (COPD) (see Chronic Obstructive Pulmonary Disease Epidemiology : has been associated with the dendriform type of diseaseDiabetes Mellitus (see Diabetes Mellitus )Epidemiology : unclear if diabetes mellitus is a risk factorDiffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage )Heavy Metal Exposure (see xxxx )Epidemiology : has been associated with the dendriform type of diseaseIdiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis )Epidemiology : has been associated with the dendriform type of diseaseOrganizing Pneumonia (see Cryptogenic Organizing Pneumonia Epidemiology : has been associated with the dendriform type of diseaseRare Earth Pneumoconiosis (see xxxx , [[xxxx]])Epidemiology : has been associated with the dendriform type of diseaseRecurrent Aspiration Pneumonia (see Aspiration Pneumonia )Solid Organ Transplant
Physiology
Heterotopic Bone Formation within the Pulmonary Tissue Potential Contributing Factors Cellular and Tissue Injury Alkaline Environment: causes precipitation of calcium salts Cessation of Pulmonary Blood Flow Collagen and Pro-Fibrogenic Cytokines Extravasation Metallic Deposition Pathologic Subtypes : however, both types may occur in the same patientDendriform : interstitial branching spicules of bone and marrow elements that may protrude into alveoliUsually Invisible on Chest X-Ray Nodular Form : intraalveolar bone deposits usually without marrow elements
Diagnosis
Serum Chemistry
Normal Serum Calcium Normal Serum Phosphate
Findings Coral-Like Dendritic Ossification Pattern in Peripheral, Basilar Regions of Lung : in dendriform typeDiffuse Interlobular and Intralobular Interstitial Thickening Smooth Contoured Lobulated Nodules : in nodular type
Less Sensitive in Patients with Milder Forms of Disease Technique : 99m technetium-methylene diphosphate (99mTc-MDP) bone scintigraphy
Transbronchial Biopsy : may be diagnostic
Restriction with Decreased DLCO : observed in extensive disease
Diagnostic Dendriform : branching bony spicules appear in the alveolar septa, usually containing fat marrowNodular Form : lobulated bone nodules within the alveolar space (absence of fat or hematopoetic cells)
Clinical Manifestations
General Comments
Disease Course : indolent or slowly progressive
Pulmonary Manifestations
Pulmonary Calcifications
Treatment
Therapies without Clinical Efficacy
References
Luschka H. Ramified ossification of the pulmonary parenchyma. Wirchows Arch 1856; 10:500–505 Extensive diffuse pulmonary ossification. Chest. 1992 Nov;102(5):1614-5 [MEDLINE ] [Diffuse pulmonary ossification associated with idiopathic pulmonary fibrosis]. Arch Bronconeumol. 2004 Dec;40(12):595-8 [MEDLINE ] Idiopathic diffuse pulmonary ossification. Thorax. 2004 Nov;59(11):1004 [MEDLINE ] Diffuse pulmonary ossification: an unusual interstitial lung disease. Curr Opin Pulm Med. 2008 Sep;14(5):488-92. doi: 10.1097/MCP.0b013e3283043e1b [MEDLINE ] The Rapid Appearance and Disappearance of Dendriform Pulmonary Ossification after Diffuse Alveolar Hemorrhage. Am J Respir Crit Care Med. 2016 Feb 1;193(3):333-4. doi: 10.1164/rccm.201506-1199IM [MEDLINE ]
Property of Kenneth J. Serio, MD. Author is not responsible for errors in content, site is for information purposes only.