Age / Sex : 12 / F

Age / Sex : 12/F

tumoral calcinosis

Discussion

Findings:

Well defined, multilobulated, and multiseptated calcifications in prepatellar soft tissue

Diagnosis:  Tumoral calcinosis

Discussion:

Clinical feature

  - Rare, familial in one third of cases

- Firm, painless, enlarging periarticular soft tissue mass

  - Children and adolescent: 6-25 years

  - Common location: hip, elbow, shoulder, foot, and wrist

  - Normal serum calcium level

  - Skin sinuses extruding chalky white material in late stage

Radiologic feature

1.       Plain radiograph

- Well defined, lobulated, septated, multiloculated calcifications in extracapsular periarticular soft tissue

 - Usually distributed along extensor surface of large joints

  - Individual calcification: 1 to 20 mm in diameter

  - Multiple linear and curvilinear radiolucencies representing fibrous septa within calcification (chicken-wire or cobblestone appearance)

2. CT

-    Lobulated cystic calcification and calcium fluid level in metabolic active lesion                     (sedimentation sign)

-    Homogeneous calcification in lower metabolic activity

- Rarely adjacent bone erosion

3.  MRI 

- T1WI: low signal intensity

- T2WI: 1) diffuse low signal intensity

       2) bright nodular pattern with alternating areas of high signal intensity and signal void

Differential diagnosis 

Calcinosis of chronic renal failure, calcinosis universalis, calcinocis circumscripta, calcific tendonitis, synovial osteochondromatosis, osteosarcoma, myositis ossificans, tophaceous gout, calcific myonecrosis

References:

1. Diagnosis of bone and joint disorders. Saunders, 2002, 4^th ed. p 4637-4641

2. Imaging of soft tissue tumors. Lippincott Williams & Wikins, 2006, 2^nd ed. p 481-482

3. Olsen KM, Chew FS. Tumoral calcinosis : pearls, polemics, and alternative possibilities.  Radiographics 2006;26:871-885