Metastatic pulmonary calcification in a patient with long dialysis vintage

A 53-year-old man with end-stage kidney disease on haemodialysis thrice weekly for 32 years due to purpura nephritis presented with exertional dyspnoea and fever. Chest radiograph revealed nodular shadows in the periphery of lung areas, especially bilateral upper lung areas (Figure 1), and computed tomography of the chest revealed high dense foci of a ground-glass appearance in bilateral upper lung areas (Figure 2A). At first, he was suspected to have infectious pneumonitis, because of opportunistic condition due to long-lasting steroid use and immunosuppressive therapy for recurrent episodes of purpura. However, the symmetrical and upper lung distribution of the lesions