CT鉴别13：钙化病灶，也会吸收，为嘛？肺钙化，熟悉的陌生人！ / 四六文摘

常记溪亭日暮，沉醉不知归路。

云南省一院孙丹雄

微信公众号

小小医生之有趣的医学！

泉水叮咚！

前言

前几天，好像看到某位大佬说，发现一位肺部感染的患者钙化病灶部分吸收！他也感到很奇怪！

神马？钙化病灶居然也会吸收？

一查文献，我又长见识了！

01 钙化吸收

国外有学者报道1例患者，一大个钙化病灶吸收了！

并且，是自行吸收了：Spontaneous Resolution of Spine Calcified Disc！

什么情况？

8岁女孩，背痛数月。影像学检查示巨大钙化椎间盘突出。

肿么办？

因为神经系统损害不严重，给予保守治疗。就是休息、减肥、避免举重物等各种损伤椎间盘的动作。随访半年以后，椎间盘钙化自行消失，椎间盘突出好转。

治疗前的磁共振：椎间盘突出！

保守治疗后，病灶自行缓解！

哎，有些人的神奇存在，就是为了专治各种不服！

piu

An 8-year-old girl was presented with back pain for several months.
Despite cord compression and syrinx formation, due to only minimal neurological deficit, the patient underwent conservative and medical management including weight loss, lifestyle modification (adapting to a correct posture and keeping the spine in normal alignment; adjustments to daily standing, sitting, and sleeping habits; avoidance of stress, heavy work, and lifting heavy objects; having more rest), and brace wearing.
After a 6-month follow-up, the control imaging showed a complete resolution of the calcified disc herniation and a decrease in syrinx size (figure 3). At the last clinical follow-up, one year later, the patient was symptom-free and hyperreflexia was improved.
Babashahi A , Taheri M , Rabiee P . Spontaneous Resolution of Symptomatic Thoracic Spine Calcified Disc Herniation: A Case Report and Literature Review[J]. Iranian Journal of Medical ences, 2019, 44(3).

巨大钙化病灶吸收

尿毒症患者，48岁，规律透析12年，骨痛、关节疼痛、全身无力和行走困难1年，症状逐渐加重，最终只能做轮椅。

骨盆、右大腿X片示巨大钙化灶！

肿么办？

患者有尿毒症、继发性甲状旁腺功能亢进，行甲状旁腺切除术！

甲状旁腺切除术后两周，他的骨痛、僵硬和虚弱症状明显改善。治疗效果堪称神奇。4周后，病人脱离轮椅，能够在没有帮助的情况下行走。

复查X片，真的是太神奇了！巨大钙化灶居然神奇消失！

piu

A 48-year-old male patient developed end-stage renal disease (ESRD) as the result of chronic glomerulonephritis and was on regular haemodialysis 3 times a week for 12 years. For the last year he had bone pain, painful
joints, general weakness and difficulty in walking. Six months prior to admission his symptoms became progressive, aggravated with movement or changing position and ultimately he became confined to a wheelchair.
Two weeks after the parathyroidectomy his symptoms of bone pain, stiffness and weakness showed striking improvement. His improvement was very impressive and 4 weeks later he was off the wheelchair and able to walk without assistance.
Sabeel A , Al-Homrany M . Complete Resorption of Massive Soft Tissue Calcification in a Hemodialysis Patient after Parathyroidectomy[J]. American Journal of Nephrology, 2000, 20(5):421-424.

03 肺部钙化灶吸收

查到一篇国内的文献，可惜没有图！Pass！还是得查国外的文献！真不省心啊！

尿毒症患者，39岁，透析治疗5年。体检发现肺部钙化灶！

肿么办？

钙化嘛，没事，放心回家去吧！

钙化也有大学问！

尿毒症患者出现钙化，很可能是钙磷代谢紊乱导致的转移性钙化！

患者有尿毒症继发的甲状旁腺功能亢进，用碳酸司维拉姆和碳酸镧治疗。

碳酸司维拉姆：本品用于控制正在接受透析治疗的慢性肾脏病（CKD）成人患者的高磷血症。碳酸镧：本品为磷结合剂，用于血液透析或持续非卧床腹膜透析 (CAPD)的慢性肾功能衰竭患者高磷血症的治疗。

18月后随访，钙化吸收。专治各种不服！

治疗前后CT对比！

piu

A 39-year-old male presented with chest radiographic findings of bilateral upper lobe nodular opacities compatible with calcification (Figures 1). The patient was on hemodialysis treatment for the past five years for chronic renal failure due to biopsy proven focal sclerosing glomerulonephritis and longstanding hypertension. Additional illnesses included hypothyroidism and anemia. The patient had no respiratory complaints. Physical examination of the lungs was normal.
Treatment with Sevelamer carbonate and lanthanum carbonate was initiated for hyperparathyroidism.
A follow-up chest CT scan performed 18 months later revealed near complete resolution of the calcified focal air space consolidation in both upper lobes. A minimal scar remained in the left upper lobe while all other lesions resolved without scarring (Figure 3A, 3B).
Silanath Peungjesada, MD; Mark Harold Baskin, MD; and Helen T Winer-Muram, MD.Metastatic pulmonary calcification.APPLIED RADIOLOGY.2016.

04 转移性肺钙化

尿毒症患者由于钙磷代谢紊乱，可导致肺转移性钙化！

典型的CT为双肺小叶中心钙化结节，双上肺为主！

05 肺钙化

病理性肺钙化可大致分为转移性钙化和营养不良性钙化！

转移性肺钙化发生在正常肺组织中，主要是由于钙和磷代谢以及碱性环境的改变导致的！

营养不良性钙化，发生在炎症过程后受损的肺部，如感染(肺结核、组织胞浆菌病、卡氏肺囊虫等)、出血或肺梗死。

也有学者这样分类：肺钙化分为转移性钙化、营养不良性钙化和异位性钙化！

异位钙化？什么鬼？

有文献这样解释：尿毒症长期透析患者因钙磷代谢紊乱易形成异位钙化，又称钙化防御或钙性尿毒症性小动脉病，是终末期肾病的严重并发症，发病率约为4.1%，是以全身小动脉钙化和组织缺血坏死为特征的一种全身血管性疾病。

搞不懂和转移性钙化有什么本质区别！文献也没有写二者的区别！醉了！

肺部异位钙化影像学可表现为双肺下叶呈明显网格样钙化！

piu

Pathological pulmonary calcifications can be broadly divided into metastatic calcifications and dystrophic calcifications. Metastatic pulmonary calcifications occur in normal lung tissue, mainly due to alterations in calcium and phosphorus metabolism and alkali environment .

Dystrophic calcifications occur in a damaged lung following an inflammatory process such as infection (tuberculosis, histoplasmosis, Pneumocystis carnii), bleeding or pulmonary infarction .

Pulmonary calcifications are divided in metastasic, dystrophic andidiopathic.