Extensive endobronchial calcification contributing to hypoxia in a quadriplegic patient

We report a rare case of a quadriplegic patient in whom the entire bronchial tree of the lower right lobe was completely occluded by calcium deposit. A 30-yr-old patient presented with hyperthermia, dyspnea, and severe hypoxia. He had been quadriplegic following spinal trauma to C4–6 nine years previously, experienced recurrent pulmonary infections and episodes of hemoptysis, and still needed a tracheostomy to remove bronchial secretions. Mechanical ventilation and antibiotics were started (levofloxacin at first empirically, later substituted for with linezolid after isolation of methicillin-resistant Staphylococcus aureus). Thoracic CT scan showed widespread consolidation in the lower right lobe (Fig. 1), and an extensive, occlusive calcification of the bronchial tree (Figs. 1 and 2), whereas arterial perfusion of the lobe was maintained (Fig. 2), resulting in severe but localized perfusion/ventilation mismatch contributing to hypoxia. In fact, despite resolution of pneumonia, gas exchanges were severely impaired (Pao2/Fio2 150). Resection of the right lower lobe resulted in an improvement of oxygenation (Pao2/Fio2 250–310) and separation from the ventilator. Three years later the patient is still breathing autonomously in a stable general condition.