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Pulmonary Ossification: Not a Bone of Contention
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A3169 - Pulmonary Ossification: Not a Bone of Contention
Author Block: A. Usmani1, M. Mallegos2, K. Haas1; 1Medicine; Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United States, 2Pathology, Jesse Brown VA, Chicago, IL, United States.
Introduction:
Pulmonary Ossification or Diffuse Pulmonary Ossification (DPO) is a chronic metaplastic process characterized by the histologic presence of bone in the interstitial or alveolar space. It is commonly an incidental finding on autopsy with very few reported cases diagnosed by lung biopsy. Here we present an interesting case of pulmonary ossification in a patient who was evaluated for abnormal imaging.
Case Synopsis:
69-year-old man with extensive prior smoking history presented to our clinic for an abnormal chest radiograph done as work up for bilateral leg swelling. He denied any pulmonary or constitutional symptoms. His previous medical history included hypertension, diabetes, and coronary artery disease status post coronary artery bypass grafting. Pulmonary exam showed a sternotomy scar with the other notable exam finding of mild lower extremity edema. Subsequent computed tomography of the thorax revealed a large lobulated mass (9cm x 4cm) in the left upper lobe. Positron emission tomography confirmed the presence an isolated mass with abnormal fluorodeoxyglucose uptake (SUV 5.7). He underwent a bronchoscopy with radial probe ultrasound guidance to biopsy the left upper lobe mass. Histopathology did not reveal any evidence of malignancy but showed bone with marrow elements. Given the high pretest probability of malignancy, he underwent left upper lobectomy via left thoracotomy. Histopathology confirmed the presence of osteogenic metaplasia and trilineage hematopoietic elements without evidence of malignancy.
Discussion:
DPO is a rare entity which was first described by Hubert von Lushka in 1856. It is more common in males and often is diagnosed in 6th or 7th decade of life. DPO is a marker of inflammation that is usually associated with chronic cardiac or pulmonary disorders though it can be seen in other systemic disorders (e.g. amyloidosis). There are two patterns of ossification; the nodular and dendriform type. Pathogenesis revolves around chronic inflammation due to injury or passive congestion that leads to influx of growth factors favoring angiogenesis and transformation of fibroblasts into osteoblasts. It is more commonly described in the lower lobes likely due to increased perfusion or passive congestion. DPO is usually asymptomatic though patients can have symptoms from the underlying cause. Pulmonary function tests may be normal but often have a mild restrictive defect. Unfortunately, there are currently no treatment options.
Author Block: A. Usmani1, M. Mallegos2, K. Haas1; 1Medicine; Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United States, 2Pathology, Jesse Brown VA, Chicago, IL, United States.
Introduction:
Pulmonary Ossification or Diffuse Pulmonary Ossification (DPO) is a chronic metaplastic process characterized by the histologic presence of bone in the interstitial or alveolar space. It is commonly an incidental finding on autopsy with very few reported cases diagnosed by lung biopsy. Here we present an interesting case of pulmonary ossification in a patient who was evaluated for abnormal imaging.
Case Synopsis:
69-year-old man with extensive prior smoking history presented to our clinic for an abnormal chest radiograph done as work up for bilateral leg swelling. He denied any pulmonary or constitutional symptoms. His previous medical history included hypertension, diabetes, and coronary artery disease status post coronary artery bypass grafting. Pulmonary exam showed a sternotomy scar with the other notable exam finding of mild lower extremity edema. Subsequent computed tomography of the thorax revealed a large lobulated mass (9cm x 4cm) in the left upper lobe. Positron emission tomography confirmed the presence an isolated mass with abnormal fluorodeoxyglucose uptake (SUV 5.7). He underwent a bronchoscopy with radial probe ultrasound guidance to biopsy the left upper lobe mass. Histopathology did not reveal any evidence of malignancy but showed bone with marrow elements. Given the high pretest probability of malignancy, he underwent left upper lobectomy via left thoracotomy. Histopathology confirmed the presence of osteogenic metaplasia and trilineage hematopoietic elements without evidence of malignancy.
Discussion:
DPO is a rare entity which was first described by Hubert von Lushka in 1856. It is more common in males and often is diagnosed in 6th or 7th decade of life. DPO is a marker of inflammation that is usually associated with chronic cardiac or pulmonary disorders though it can be seen in other systemic disorders (e.g. amyloidosis). There are two patterns of ossification; the nodular and dendriform type. Pathogenesis revolves around chronic inflammation due to injury or passive congestion that leads to influx of growth factors favoring angiogenesis and transformation of fibroblasts into osteoblasts. It is more commonly described in the lower lobes likely due to increased perfusion or passive congestion. DPO is usually asymptomatic though patients can have symptoms from the underlying cause. Pulmonary function tests may be normal but often have a mild restrictive defect. Unfortunately, there are currently no treatment options.
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