Miliary Calcification of the Lung: Etiologic Aspects

Publisher Website
Google Scholar
Abstract
Every radiologist has seen numerous instances of discrete miliary calcified nodules widely distributed throughout the lung fields in patients who were apparently otherwise well. Because of the distribution of these nodules, and in the absence of proof of other etiology, they have generally been regarded as evidence of healed miliary tuberculosis. Only in recent years have epidemiologic studies demonstrated that in many patients the tuberculin reaction is negative, and where large series have been studied, the incidence of pulmonary calcification has been found to agree more closely with the number of positive histoplasmin reactors than of positive tuberculin reactors. In this communication we shall review the subject briefly and report a group of cases which we have had under observation for almost ten years, following the changing roentgen picture from the earliest evidence of disease to the stage of nodular calcification. Two cases in which there is little doubt as to a tuberculous etiology will also be included. Blaine (2) was among the earlier writers to assume that the disseminated pulmonary calcifications occasionally demonstrated roentgenologicallyrepresented a healed miliary tuberculosis. He reported three cases, basing his conclusion as to the etiology of the lesions upon the striking resemblance of the distribution of the shadows to the appearances in acute miliary tuberculosis. None of his patients showed convincing clinical evidence of tuberculosis and in none was postmortem proof of the nature of the nodules obtained. Sante (12), at about the same time, described a similar case, in which calcareous deposits in the lung showed little change over a period of nearly a year. While no positive evidence of tuberculosis was obtained, he concluded that the opmion of able pathologists and roentgenologists up to that time furnished “sufficient authority for a provisional diagnosis of healed miliary tuberculosis.” In a case of diffuse mottling throughout both lungs reported by Pierson (10), a lymph node biopsy suggested tuberculous involvement, but two years later the patient, without treatment or further observation, was well and the lungs had completely cleared. Two other cases of miliary calcification were attributed by Pierson to miliary tuberculosis but without clinical support. Sutherland (15) reported a series of 38 cases of miliary calcification of the lungs and, in the absence of evidence of a tuberculous etiology, suggested the possibility of calcium metastasis, but this theory has been largely discarded. Two cases of recovery from what was believed to be miliary tuberculosis were published in 1929 by Marlow (7). In the first case, miliary lesions in the lungs were observed for two years. Biopsy of associated cutaneous lesions led to a diagnosis of tuberculosis, but no tubercle bacilli were found in these lesions or in the sputum. The second patient had undergone nephrectomy for renal tuberculosis, and the mottling in the lung fields was considered to be of tuberculous origin. The patient refused treatment, however, and was apparently well and working one year later. In this case, also, the sputum was negative for tubercle bacilli.

This publication has 1 reference indexed in Scilit: