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Case of the Week 246

What's the most likely diagnosis?

  • 42 year-old chronic renal patient

  1. Hamartoma
  2. Tuberculosis
  3. Sarcoid
  4. Metastatic calcification
  5. Asbestosis



4. Metastatic calcification



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Metastatic Calcification

General considerations

  • Metastatic calcification refers to deposition of calcium salts in previously normal tissue
  • Due to disturbance in calcium/phosphorus metabolism
    • Most likely to develop when the calcium/phosphorous product exceeds 70, but may occur at normal values
  • Most commonly related to persistently elevated calcium levels as in:
    • Primary hyperparathyroidism
    • Chronic renal disease
      • Seen in 60-80% of autopsied hemodialysis patients
    • Milk-alkali syndrome
    • Hypervitaminosis D
    • Widespread bone destruction from metastases or myeloma
  • Alkaline tissue environment thought to make such deposits more likely, so that most common organs involved are:
    • Lungs
    • Gastric mucosa
    • Kidney

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