A chest x-ray with a "starry sky"

A 56-year-old woman presented to the emergency room with palpitations. In the context of the emergency diagnosis, there was no indication of an acute event. The chest x-ray revealed surprising finding. There were multiple, 1–2 mm thick, calcareous round shadows disseminated over both lungs. In the differential diagnostic considerations, the discussion of the findings with the patient provided the decisive clue. As young adult, she was seriously ill with varicella pneumonia. She was well aware of the abnormalities of the x-ray. Disseminated micronodular calcifications as residues of past varicella pneumonia are described in the literature as typical, but rare. Other possible differential diagnoses, such as silicosis or calcified metastases, were not further clarified because of the detailed anamnesis. The calcification of the foci, the high density of which is clearly visible in comparison to the ribs, spoke against miliary tuberculosis. "Starry sky" - term that is often used to describe varicella rash - can also be associated with the patient's x-ray.

Dr. med. Andreas Lindner, MSc, Department of Gastroenterology and Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum Berlin, AKLindner@gmx.de

Jürgen Härer, Institute for Radiology and interventional therapy, Vivantes Auguste-Viktoria-Klinikum Berlin

Dr. med. Hartmut Stocker, Department of Gastroenterology and Infectiology, Vivantes Auguste-Viktoria-Klinikum Berlin

Conflict of interest: The authors declare that there is no conflict of interest.

►The German version of this article is available online: www.-international. de