Metastatic pulmonary calcification in a patient with end-stage renal disease on hemodialysis: A common complication but a rare clinical diagnosis

Metastatic pulmonary calcification (PC) is the deposition of calcium salts in normal lung tissue, usually as a result of abnormalities of calcium or phosphorus metabolism. Most commonly PC is seen in patients with chronic renal failure who are on hemodialysis. However, PC is diagnosed rarely-not only because of its often benign clinical course, but also as a result of the low sensitivity of standard chest radiographs to detect the calcification. Calcifications therefore are most often found on autopsy. Presented is a case of metastatic PC leading to hypoxemia in a patient with end-stage renal disease on hemodialysis. The diagnosis was initially not considered and the patient underwent a thoracotomy and biopsy. A higher index of suspicion followed by a less invasive technetium-99m-labeled bone scan would have aided in making the diagnosis, thus avoiding the need for lung biopsy.