Rim Lakhdhar
A. Berrais
Med Akram Drissa
Mehdi Cheour
Najoua Essefi
Habiba Drissa


Background : Diffuse pulmonary ossification is a rare entity with unknown pathogenesis. It presents with the formation of mature bone within the pulmonary parenchyma. Pulmonary ossification can be idiopathic or associated with diffuse and chronic lung disease, system disorders or heart disease essentially mitral stenosis.
Aim: We report a case of a 49 year-old woman with long standing mitral stenosis.
Case: The patient had undergone a valve replacement with a mechanical prosthesis. She complains from dyspnea on exertion and dry cough. Frontal chest radiograph shows bibasilar confluent calcific areas of increased opacity. Computed tomography scans confirmed the presence of ossified acinar clusters. Other aetiologies of diffuse pulmonary ossification were eliminated by different complementary exams.
Conclusion : Diffuse pulmonary ossification is slowly progressive. Patients are generally asymptomatic or complain from mild symptoms. Most cases are of diffuse pulmonary ossification are diagnosed during autopsy. Establishing a prognosis is difficult as few living cases are diagnosed.


Mitral valve, mitral stenosis, pulmonary ossification



  1. Woolkey K, Stark P. Pulmonary parenchymal manifestations of mitral valve disease. Radiographics. 1999; 19: 965-72.
  2. Friedrich T, Steinecke R, Horn LC, Eichfeld U. Idiopathic pulmonary ossification. Rofo Fortschn Geb Rontgenstr Nenen Bildgeb Verfahr. 1998; 169: 267-73.
  3. Fraser RG, Paré PD, Fraser RS, Genereux GP. Diagnosis of diseases of the chest. 3rd ed. Vol2. Philadelphia, Pa: Saunders. 1989; 1863- 79.
  4. Galloway RW, Epstein EJ, Coulshed N. Pulmonary ossific nodules in mitral valve disease. Br Heart J. 1961; 23: 297-304.
  5. Lushka H. Verastige Knochenbildung im parenchyma der lung. Virchows Arch. 1856; 10: 500-5.
  6. Chan ED, Morales DV, Welsh CH, MC Dermott MT, Schwarz MI. Calcium deposition with or without bone formation in the lung. Am J Respir Crit Care Med. 2002; 165: 1654-69.
  7. Fernández Crisoto CA, Quercia Arius O, Bustamante N, Moreno H, Uribe Echevarría A. Diffuse Pulmonary Ossification Associated With Idiopathic Pulmonary FibrosisArch Bronconeumol 2004;40 : 595-8
  8. Fried ED, Codwin TA. Extensive diffuse pulmonary ossification. Chest. 1992; 102: 1614-15.
  9. Tseung, Jason, Duflon, Johan. Diffuse pulmonary ossification: an uncommon incidental autopsyfinding. Pathology. 2006; 38: 45-48.
  10. Jadeborg JM, Dunton RF. Rare clinical diagnosis of dendriform pulmonary ossification. Ann Thorac Surg. 2001; 71: 2009-11.
  11. Lingam RK, Tah J, Sharma A, Friedman E. Metastatic pulmonary calcification in renal failure: a new HRCT pattern. The British Journal of Radiology. 2002; 75: 74-77.
  12. Ryan CF, Flint JD, Müller NL. Idiopathic diffuse pulmonary ossification. Thorax. 2004; 59: 1004.
  13. Poletti V, Costabel U, Caroni GL, Bigliazzi C, Rent MD, Olivieri D. Rare infiltrative lung diseases: a challenge for clinicians. Respiration. 2004; 71: 431-443.
  14. Green JD, Hale TS, Greenberg SD, Weg JG, Nevin H, Jenkins DE. Dissiminated pulmonary ossification. Am Rev Resp Dis. 1970; 101: 293-98.
  15. induced by bone morphogenetic protein and recombinant human interleukin. Clin Orthop 1988;237:236-244.
  16. Gevenois PA, Abehsera M, Knoop C, Jacobovitz D, Estenne M. Disseminated pulmonary ossification in end-stage pulmonary fibrosis: CT demonstration. AJR Am J Roentgenol 1994;162:1303-1304.
  17. Chow IT, Shum BSF, Chow WH, Tso CB. Diffuse pulmonary ossification: rare complications of tuberculosis. Histopathology 1992; 20: 435-437.
  18. Kayser K, Stute H, Tuengerthal S. Diffuse pulmonary ossification associated with metastatic melanoma of the lung. Respiration 1987;52: 221-227.
  19. Muramatsu T, Hamano H, Fukumashi K, Shiigai T, Fujiseki M, Katayanagi T, Osada K, Inoue T, Shimono M. An experimental study of chondrogenesis and osteogenesis in rat submandibular gland induced by implantation of demineralized dentin. Bull Tokyo Dent Coll 1993;34:15-22.
  20. Birzele J, Schmitz I, Muller KM. Ossification in lung metastases of primary colorectal adenocarcinomas. Pathologe 2003;24:66-9.