Age / Sex : 41 / M

Chief complaint : palpable back mass for 3 month

PHx : ESRD with HD (for 5 years)

What is your diagnosis?


Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy: 이로운 (Ro-Woon, Lee), 인하대병원(Inha University Hospital)

Tumoral calcinosis-like metastatic calcification

Discussion

Disease definition
Tumoral calcinosis-like metastatic calcification in a patient with uremia on dialysis has rarely been reported in the radiological literatures. These deposits predominantly form around large articular areas and cause intolerable pain and skin ulceration. Epidemiological data indicate that morbidity is approximately 0.5–3% in patients receiving hemodialysis. Tumocal calcinosis-like metastatic calcification might originate from secondary hyperparathyroidism (SHPT). The main reasons explaining this finding include high-turnover bone disease, treatment of hyperphosphatemia with calcium-containing phosphate binders and active vitamin D, and increased calcium and phosphate loads.

Findings
1. In this case, tumoral calcinosis-like metastatic calcification has a typical appearance on plain radiograph and CT scan with amorphous and multilobulated ("cloud-like") calcification located in interspinous and paraspinal area.
2. MR imaging with T1 and T2-weighted sequences shows inhomogeneous dark-signal intensity mass like lesion in interspinous and paraspinal area.

Differential diagnosis

1. calcium pyrophosphate deposition disease (CPPD)


2. myositis ossificans


3. tophaceous gout

• Hwang ZA, Suh KJ, Chen D, Chan WP, Wu JS. Imaging Features of Soft-Tissue Calcifications and Related Diseases: A Systematic Approach. (2018) Korean journal of radiology. 19 (6): 1147-1160. doi:10.3348/kjr.2018.19.6.1147


• YT Huang et al. Tumoral calcinosis-like metastatic calcification in a patient on renal dialysis. Clin Imaging. Jan-Feb 2006;30(1):66-8. doi:10.1016/j.clinimag.2005.06.024.