Metastatic pulmonary calcifications after cardiac surgery in children

Six children in whom pulmonary calcifications developed after open heart surgery are described. Asymptomatic alveolar lesions appeared within the first 3 weeks after surgery, during or after intensive care. They were first diagnosed as possible infection or edema and secondarily identified as calcifications in the lungs. In five patients, the pulmonary calcifications partially decreased or disappeared, and the prognosis did not seem to be altered. In one patient, the pulmonary calcifications were associated with cardiac calcifications leading to death. The mechanism of these pulmonary calcifications is thought to be predominantly or exclusively metastatic and partially iatrogenic. Data indicated two major causative factors: therapy with massive doses of calcium and postsurgical acute renal failure. Radiographic findings of persistent alveolar lesions of increasing density in patients undergoing antibiotic therapy after open heart surgery are suggestive of the diagnosis of metastatic pulmonary calcifications. Scintigraphy with bone agents or computed tomography is recommended for early confirmation and prevention of therapeutic errors, especially after cardiac transplantation.