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Abstract: PO0394

Rapidly Growing "Calcified Cauliflower" in the Lung of an Orthotopic Heart Transplant (OHT) Recipient on Hemodialysis (HD)

Session Information

Category: Trainee Case Report

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Song, Rui, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Arif, Ali, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Dass, Chandra, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Lee, Iris J., Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Abdelwahab, Dina, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
Introduction

Pulmonary calcinosis is commonly seen in ESRD patients but rarely in OHT recipients. We report a rare case of an OHT recipient who developed AKI requiring RRT. CT chest was noted for rapid progressive calcifications of lungs with both dystrophic and metastatic features.

Case Description

A 48-year old male with non-ischemic cardiomyopathy who underwent OHT. The post-transplant course was complicated by biventricular failure requiring VA/ECMO and IABP support, aortic anastomotic bleeding, multiple surgeries, recurrent bacterial and viral pneumonia dependent on mechanical ventilation, and ischemic acute tubular injury requiring CRRT then switched to HD. The imaging was noted for cardiac calcification, followed by rapidly progressive lung calcification. CT chest showed diffuse ground-glass opacity and “calcified cauliflower” signs with a mixture of dystrophic and metastatic lung calcifications. Work up for hyperparathyroidism, vitamin D toxicity, malignancy was negative. Contributing factors for pulmonary calcinosis included multiple surgeries, infections of the lungs, massive transfusion with subsequent IV calcium repletion, calcium concentration in replacement fluid of CRRT, use of calcium acetate. Subsequently, the patient was put on the lowest calcium bath and longer HD hours.

Discussion

Dystrophic pulmonary calcification occurs in the injured lung due to inflammation, infection, or hemorrhage. While metastatic calcification is more common in ESRD patients, primary and secondary hyperparathyroidism, or malignancy. Our case report emphasizes the importance of bone mineral disease as an underlying etiology for pulmonary calcinosis in dialysis-dependent OHT patients. The supportive approach includes avoidance of massive transfusions, IV calcium infusion, and calcium-based phosphorus binder, use of low calcium bath in HD.

CT chest: cauliflower calcification bilaterally