Age / Sex : 58 / F

Age / Sex : 58/F

Tumoral calcinosis-like metastatic calcification in CRI (secondary hyperparathyroidism, renal osteodystrophy).

Discussion

Findings: Coronal CT scan of neck shows bilateral multiloculated cyst-like calcified masses within the soft tissues of the neck. One of the cyst-like space measured 271HU and 272 HU before (not shown) and after contrast medium administration, respectively. CT scans of chest and thigh show similar multiloculated cyst-like calcified masses in soft tissues of both chest walls and thighs. Adjacent ribs were eroded by the calcified masses.  Incidentally noted were bilateral renal cortical thinnings with multiple renal cysts on coronal chest CT.  US of right kidney shows small sized kidney with increased cortical echogenicities and adjacent ascites.

Differential Diagnosis: Metastatic calcification in chronic renal insufficiency, Congental tumoral calcinosis,  Connective tissue disease, hypervitaminosis D, Primary hyperparathyroidism.

 Diagnosis: Tumoral calcinosis-like metastatic calcification in chronic renal insufficiency.

Discussion: Renal osteodystrophy is a musculoskeletal disease associated with chronic renal failure and usually occurs in people who have received renal dyalysis for over 3years. Although pathogenesis is not fully understood, two proposed mechanism are secondary hypeprparathyroidism and abnormal vitamin D metabolism. Tumoral calcinosis and tumoral calcinosis-like metastatic calcifications are can be seen in uremic patient, accompanying secondary hyperparathyroidism and renal osteodysptrophy. The condition is characterized by multiple large calcified masses resembling neoplasm located in soft tissues along the extensor surface of hip, shoulder. elbow. The size of the lesion varies from 2 to 10cm in diameter. Most masses are asymptomatic. The activity of mass can be suggested when mass contains cystic spaces whereas collagen sclerosis without fluid may indicate inactivity.

 References:

1. Yung-Tsung Huang, Chin-Yuen Chen at al. Tumoral calcinosis-like metastatic calcification in a patient on renal dialysis ; Case report. Journal of Clinical Imaging  2006;30: 66-68.

2. Kathryn M. Olsen, MD at al. Tumoral calcinosis: Pearls, Polemics, Alternative possibilities. Radiographics 2006;26: 871-885.

3. Mark D. Murphey MD, Davd Sartoris, MD at al. Musculoskeletal Menifestation Chronc Renal Failure. Radiographics 1993; 31:357-379.