PMC7236054_01
Chest-X-ray. (A) One month prior to admission to our hospital, there were no abnormal chest shadows. (B) New bilateral infiltrates were detected on the day of admission.
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Chest X-ray showed bilateral infiltrates (Fig. 1) and chest computed tomography (CT) revealed bilateral ground-glass opacities (Fig. 2).
The clinical course of the patient.. AZM: azithromycin, CHDF: continuous hemodiafiltration, mPSL: methylprednisolone, PIPC/TAZ: piperacillin/tazobactam, PSL: prednisolone, VV-ECMO: veno-venous extracorporeal membrane oxygenation.
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Her clinical course for the first 14 days after admission is shown in Fig. 3.
Computed tomography finding of the left parathyroid grand. Swelling of the parathyroid grand was detected (arrow).
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Evaluation revealed that intact PTH levels on the day of admission were extremely high (3463.3 pg/mL) and CT image on the day of admission showed swelling of her left parathyroid gland (Fig. 4).
Parathyroid scintigraphy obtained on day 33 demonstrated a left parathyroid tumor (arrow).
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Moreover, the results of parathyroid scintigraphy were consistent with parathyroid tumor (Fig. 5).
Chest computed tomography. A and B are images on the day of admission. C and D are images obtained on day 13. E and F are the images of day 45. Follow-up chest CT scans showed calcification in both lungs (C-F). G and H are images obtained 4 months after parathyroidectomy, and they demonstrated improvement in pulmonary calcification.. CT: computed tomography.
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Follow-up chest CT scan showed calcification in both lungs (Fig. 6C-F), and Tc-99m hydroxymethylene diphosphonate scintigraphy also showed diffuse uptake in both lungs (Fig. 7). Four months after surgery, follow-up CT scan revealed improvement in pulmonary calcification bilaterally (Fig. 6G and H).
Hematoxylin and eosin staining of tissue sections obtained by transbronchial lung biopsy (A) and parathyroidectomy (B). Calcification was detected in small vessel walls in the lung biopsy specimen (arrows).
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Finally, transbronchial lung biopsy obtained on day 47 revealed microscopic calcification in small vessel walls, which is consistent with MPC (Fig. 8). Based on the above results, parathyroidectomy was performed on day 48, the pathological findings of which were consistent with parathyroid adenoma (Fig. 8).