[Diffuse pulmonary ossification associated with idiopathic pulmonary fibrosis]

Area of Science:

• Pulmonology
• Pathology
• Radiology

Background:

• Diffuse pulmonary ossification (DPO) is a rare condition characterized by mature bone formation within lung tissue.
• It is typically associated with chronic lung diseases, heart conditions, or systemic disorders.
• DPO is most often identified as an incidental postmortem finding by pathologists.

Observation:

• This report details a case where DPO was diagnosed in a living 79-year-old male smoker presenting with dyspnea, cough, and weight loss.
• Radiological imaging revealed bilateral reticulonodular infiltrates, interstitial disease with honeycomb patterns, pleural thickening, and fibrosis.
• An open lung biopsy was performed due to a clinical diagnosis of interstitial fibrosis.

Findings:

• Histopathological examination of lung tissue showed alveolar collapse, emphysema, vascular congestion, and inflammation.
• Crucially, the biopsy identified predominantly interstitial, multicentric foci of osseous trabeculae, some containing adipose bone marrow.
• These findings confirmed the diagnosis of diffuse pulmonary ossification in a living patient.

Implications:

• Diagnosing DPO in living patients is unusual, contrasting with its common postmortem identification.
• While DPO itself holds no prognostic significance in pulmonary fibrosis, its presence signifies chronicity and/or severity of the underlying lung disease.
• This case highlights the importance of histopathological analysis for diagnosing rare pulmonary conditions in vivo.