TY - JOUR T1 - Nodular pulmonary ossifications in differential diagnosis of solitary pulmonary nodules JF - European Respiratory Journal JO - Eur Respir J SP - 966 LP - 968 DO - 10.1183/09031936.00134110 VL - 37 IS - 4 AU - J. Gielis AU - M. Torfs AU - M. Luijks AU - R. Salgado AU - P.E. Van Schil Y1 - 2011/04/01 UR - http://erj.ersjournals.com/content/37/4/966.abstract N2 - To the Editors:When considering a solitary pulmonary nodule or coin lesion, the differential diagnosis comprises a lot of different disease entities. Although uncommon, in specific patient groups, pulmonary ossifications should also be considered. We report two patients in whom the diagnosis of pulmonary ossification was confirmed pathologically and present a general discussion on this subject.First, in a 68-yr-old patient with a history of hypercholesterolaemia and hypertension, a suspicious right mediastinal shadow was incidentally found on chest radiography after insertion of a central venous line. Personal history revealed poliomyelitis, retinal detachment and, especially, ventricular flutter for which he was resuscitated. Afterwards, he suffered from memory disturbances and even a frontal syndrome. A cardioverter–defibrillator was implanted. Chest radiography revealed a nodular aspect in the right lung hilum, which was not seen on a previous radiogram. Subsequent chest computed tomography (CT) demonstrated enlarged lymph nodes but no apparent ossifications. The mediastinum showed high metabolic activity on positron emission tomographic scan. Transbronchial biopsy was not conclusive. Cervical mediastinoscopy was negative. Subsequently, the right hilum was explored by thoracotomy. Enlarged lymph nodes were discovered and a wedge resection of the right middle lobe was performed to remove a calcified nodule of ∼1 cm, surrounded by other small calcified lesions. Pathology demonstrated metaplastic bone tissue in the alveolar spaces and cores of ossification were diffusely spread across the pulmonary parenchyma. Diagnosis of diffuse nodular pulmonary ossification was made. Signs of pulmonary hypertension, such as intimal proliferation and focal myxoid degeneration of the parenchymal blood vessels … ER -