A 52-year-old man presented with chest pain, cough, and right hip pain radiating to the lower limbs for 2 months. Chest, abdominal, and pelvic CT scans demonstrated the presence of a mass with stippled calcification in the right lung (Figure 1A), a calcified mass in the liver (Figure 1B), and a lytic lesion in the right ischium (Figure 1C). PET/CT showed high fluorodeoxyglucose uptake in all lesions (Figure 1D).

 
The patient had a history of a moderately differentiated sigmoid adenocarcinoma, treated 6 years prior. Staging chest and abdominal CT examinations performed at the time showed no other lesions. Lung, liver, and ischial lesions were biopsied, and all corresponded to intestinal adenocarcinoma metastases. The patient was given palliative chemotherapy.
 
Calcifications in primary nodules suggest a benign nature, generally corresponding to granulomas or hamartomas. Several extrapulmonary primary tumors, however, are associated with calcified or ossified pulmonary metastases. These include osseous sarcomas, particularly osteosarcomas, papillary and mucinous adenocarcinomas, testicular and ovarian tumors, and medullary carcinomas of the thyroid.(1,2)
 
REFERENCES
 
1.            Kavanagh E,  Gleeson T, Hargaden G, Fenlon H. Metastatic colorectal carcinoma: an unusual cause of calcified pulmonary metastases. AJR Am J Roentgenol 2004 Dec;183(6):1841-3. https://doi.org/10.2214/ajr.183.6.01831841.
2.            Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001;21(2):403-17. https://doi.org/10.1148/radiographics.21.2.g01mr17403.