Images in Pulmonary MedicineThe Imaging Evaluation of Pulmonary Ossification: How HRCT May be Useful in the Diagnosis of a Rare DisorderTomich, Jennifer MD; Gyurjyan, Harutyun MD; Shaves, Sarah MDAuthor Information Department of Radiology, Eastern Virginia Medical School, Norfolk, VA The authors declare that they have nothing to disclose. Address correspondence to: Jennifer Tomich, MD, Department of Radiology, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501. E-mail: firstname.lastname@example.org. Clinical Pulmonary Medicine: November 2013 - Volume 20 - Issue 6 - p 317-319 doi: 10.1097/CPM.0000000000000000 Buy Metrics Abstract Diffuse pulmonary ossification is a rare condition characterized by heterotopic bone formation within the lung parenchyma. Diagnosis is ultimately made by histology, which demonstrates islands of ossification within the connective tissues or alveoli of the lungs. The disease remains underrecognized clinically, with most reported cases identified by autopsy series. However, with the advent of high-resolution computed tomography, our ability to identify these patients early has improved. High-resolution computed tomography is able to identify smaller foci of pulmonary ossification with greater specificity than standard computed tomography imaging. In this article, we use an example case to illustrate the classic imaging features of pulmonary ossification, which presents as high-density (400 to 500 HU) ossification of the alveoli or connective tissues with lower lobe predominance. Two main patterns of ossification have been described: nodular and dendriform. Both patterns can coexist in the same patient; however, the predominant pattern may suggest the underlying etiology. The nodular pattern is most commonly associated with chronically elevated central venous pressure, whereas the dendriform pattern is associated with chronic inflammation. Increased recognition and early diagnosis of this condition may lead to improved treatment strategies for these patients in the future. © 2013 by Lippincott Williams & Wilkins, Inc.