Metastatic pulmonary calcification mimicking refractory pneumonia in an end stage renal disease patient: A diagnostic pitfall.

Metastatic pulmonary calcification may mimic infectious lung disease in patients with end-stage renal disease, resulting in delayed diagnosis and repeated ineffective treatment. We report a 71-year-old hemodialysis patient with persistent dyspnea and progressive pulmonary infiltrates repeatedly treated as pneumonia without improvement. CT demonstrated high-attenuation consolidation and diffuse ground-glass opacities, while preserved oxygen saturation despite extensive radiographic abnormalities argued against severe infection. Technetium-99m methylene diphosphonate bone scintigraphy later confirmed metastatic pulmonary calcification associated with secondary hyperparathyroidism. This case highlights the importance of recognizing clinical-radiologic mismatch and the diagnostic value of Technetium-99m methylene diphosphonate bone scintigraphy in metastatic pulmonary calcification.