key: cord-0933442-ahtt3ncc
authors: Torres, Pedro Paulo Teixeira e Silva; Rabahi, Marcelo Fouad; Marchiori, Edson
title: Dendriform pulmonary ossification in coronavirus disease 2019 pneumonia
date: 2022-03-14
journal: Revista da Sociedade Brasileira de Medicina Tropical
DOI: 10.1590/0037-8682-0621-2021
sha: 33d94fb8cfb0ce0b74d83fd2cdfe2fc07e9921a8
doc_id: 933442
cord_uid: ahtt3ncc

nan

Pedro Paulo Teixeira e Silva Torres [1]  , Marcelo Fouad Rabahi [2] , [3]  and Edson Marchiori [4]  [1] . Multimagem Diagnósticos, Goiânia, GO, Brasil. [2] . Hospital Geral de Goiânia, Goiânia, GO, Brasil.

[3]. Universidade Federal de Goiás, Goiânia, GO, Brasil.

[4]. Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

A 54-year-old man presented with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) positivity after experiencing flu-like symptoms. His condition progressed to acute respiratory failure, and he was placed on mechanical ventilation. Chest computed tomography (CT) showed bilateral ground-glass opacities with mild reticulation ( Figure 1A) . The patient was treated with supportive measures, including antibiotic therapy and corticosteroid therapy. He recovered well and was discharged. Two months later, he presented with worsening dyspnea and cough. A new CT showed improvement in the ground-glass opacities but a progression of the reticular opacities, with traction bronchiectasis on the anterior aspect of the superior lobes. Interstitial calcifications compatible with dendriform pulmonary ossification (DPO) were observed over the reticular abnormalities (Figure 1B-D) . Steroid treatment improved the patient's overall clinical condition.

Diffuse pulmonary ossification is a rare chronic process characterized by the formation of small mature bone fragments in the pulmonary parenchyma. It is classified as nodular or dendriform, with the former usually occurring in the context of chronic congestion. DPO is an interstitial process that occurs in the setting of fibrosing interstitial lung disease. It may evolve with osseous metaplasia, which is seen as nodular and branching calcifications in imaging studies. This pattern has been observed mainly in areas of reticulation rather than in honeycombing 1-3 .

Another condition recently related to DPO is cicatricial organizing pneumonia. This distinctive form of organizing pneumonia may manifest as persistent linear opacities that mimic fibrosing interstitial pneumonia. It may also be displayed as ossification foci in imaging and pathology studies 2 . Our case demonstrates the manifestation of extensive DPO, probably related to cicatricial organizing pneumonia, after coronavirus disease 2019 pneumonia.

Accelerated Pulmonary Ossification as a Sequela of SARS-CoV-2 Pneumonia

Cicatricial Organizing Pneumonia with Dendriform Pulmonary Ossification: An Unusual Cause for a Recurrent Pneumothorax

Diffuse Pulmonary Ossification in Fibrosing Interstitial Lung Diseases: Prevalence and Associations