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LETTER TO EDITOR
Year : 2019  |  Volume : 36  |  Issue : 3  |  Page : 269-270  

Diffuse tracheobronchial calcinosis in a geriatric patient with chronic kidney disease


1 Department of Nephrology, SBU Tepecik Education and Research Hospital, Izmir, Türkiye
2 Department of Pulmonology, SBU Tepecik Education and Research Hospital, Izmir, Türkiye

Date of Web Publication24-Apr-2019

Correspondence Address:
Dr. Levent Usta
Department of Pulmonology, SBU Tepecik Education and Research Hospital, Izmir
Türkiye
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_10_19

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How to cite this article:
Alp A, Usta L. Diffuse tracheobronchial calcinosis in a geriatric patient with chronic kidney disease. Lung India 2019;36:269-70

How to cite this URL:
Alp A, Usta L. Diffuse tracheobronchial calcinosis in a geriatric patient with chronic kidney disease. Lung India [serial online] 2019 [cited 2019 Sep 18];36:269-70. Available from: http://www.lungindia.com/text.asp?2019/36/3/269/256911



Sir,

An 82-year-old woman presented with complaints of loss of appetite and reduced urine output. Her medical history included hypertension and hypothyroidism. In addition to candesartan cilexetil and levothyroxine sodium, she reported frequent use of nonsteroidal anti-inflammatory drugs. On physical examination, her blood pressure was 160/80 mmHg and pulse was 98/min. Lung sounds were normal. Basal creatinine values were ambiguous. At the time of presentation, her laboratory values were: urea = 139 mg/dL, creatinine = 5.7 mg/dL, glomerular filtration rate = 7.57 mL/min/1.73 m2, potassium = 6.7 mmol/L, calcium = 7.8 mg/dL (adjusted), phosphorus = 4.6 mg/dL, venous blood gas pH = 7.21, bicarbonate = 15.2 mmol/L, hemoglobin = 7.9 g/dL, hematocrit 24.3%, and Parathormone (PTH) =297.2 ng/L. Urgent hemodialysis was performed due to findings of hyperkalemia and hypervolemia. Prominent and calcified tracheal borders were observed on conventional posteroanterior chest X-ray. Computed tomography of the thorax also revealed calcification throughout the tracheobronchial tree [Figure 1] and [Figure 2]. Based on the findings of elevated PTH level, anemia, signs of Grade 2 hypertensive retinopathy on fundoscopy, and increased renal parenchymal echogenicity on urinary ultrasound, the patient was diagnosed with chronic kidney disease (CKD). A tunneled hemodialysis catheter was placed and she was enrolled in a chronic dialysis program (3/7).
Figure 1: Posteroanterior chest X-ray showing diffuse tracheobronchial calcification with distinct borders

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Figure 2: Thoracic computed tomography: transverse sections showing tracheal, carinal, and bronchial calcifications

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Tracheobronchial calcinosis is a rare radiological finding in adults, with an incidence of <1%.[1] Various factors have been implicated in its etiology, including sarcoidosis, warfarin use, tracheobronchopathia osteochondroplastica generally manifesting with nodular calcifications, relapsing polychondritis, amyloidosis, and advanced age.[2],[3] Respiratory symptoms related to airway stenosis may occur, such as hemoptysis and dyspnea, or the condition may be completely asymptomatic. Our patient did not have a history of pulmonary disease or respiratory complaints. Other clinical conditions were ruled out with simple tests. Despite the diagnosis of CKD, there was no marked elevation in her calcium, phosphorus, or PTH levels. We believe that tracheal calcification was not primarily associated with CKD but was an incidental finding. In this age group, and especially in females, tracheal calcinosis may be encountered as an asymptomatic and incidental finding. In such cases, clinical and laboratory evaluation should have priority, and prudence is warranted when considering risky invasive procedures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fukuya T, Mihara F, Kudo S, Russell WJ, DeLongchamp RR, Vaeth M, et al. Tracheobronchial calcification in members of a fixed population sample. Acta Radiol 1989;30:277-80.  Back to cited text no. 1
    
2.
Li D, Shi Z, Wang Y, Thakur A. Primary tracheobronchial amyloidosis: Coronal CT scan may provide clues for early diagnosis. J Postgrad Med 2013;59:223-5.  Back to cited text no. 2
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3.
Chatterjee K, Sen C. Warfarin-induced tracheobronchial calcification. Indian J Vasc Endovasc Surg 2015;2:84-5.  Back to cited text no. 3
  [Full text]  


    Figures

  [Figure 1], [Figure 2]



 

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