Pulmonary calcification in long-term hemodialysis: a mimic of pulmonary thromboembolism

Metastatic pulmonary calcification is a frequent complication of chronic renal failure, especially in patients undergoing maintenance hemodialysis. We report a patient with chronic renal failure, who developed chest pain and hypoxia suggestive of pulmonary thromboembolism (PTE) and subsequently died. The ventilation/perfusion (V/Q) scan was also interpreted as consistent with PTE. At autopsy the areas of reduced perfusion on the scan corresponded to the areas of pulmonary calcification with no evidence of PTE. Physicians should be aware that this condition may mimic PTE, and that pulmonary angiography may be necessary to confirm the diagnosis prior to the initiation of anticoagulation.