Heterogeneous manifestation of pulmonary ossification in idiopathic pulmonary fibrosis

Diffuse pulmonary ossification (DPO) is an uncommon pathological condition characterized by bone formation in the lung parenchyma. Historically, these findings have mostly been identified at the time of autopsy. With the increasing use of high-resolution computed tomography (HRCT) and surgical lung biopsy, DPO has been more frequently recognized. We describe two patients with concurrent diagnoses of idiopathic pulmonary fibrosis (IPF) and DPO with different clinical presentations, pathologic features and outcomes. DPO in IPF is a rare finding but may have significant implications in making a radiographic diagnosis and in the correct setting may obviate the need for a surgical lung biopsy.