Age / Sex : 30 / M

Chief complaint: both hip pain

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy: 송호택(Ho-Tack Song) / 이영한(Young Han Lee), 세브란스병원(Severance Hospital)

Tumoral calcinosis

Discussion

Findings:

Plain: Amorphous,
cystic, and multilobualated calcified mass at periarticular are of both hip

MRI: Heterogeneous
signal mass with multiple cystic components with fluid-fluid level at periarticular
side of both hip

Differential Diagnosis:

1. Cause of
dystrophic calcification

2.
Neoplastic disease, synovial sarcoma, osteosarcoma, chondrosarcoma

3.
Metaplasia: synovial osteochondromatosis

4. Calcium
pyrophosphate deposition disease.

Diagnosis: Tumoral calcinosis

Discussion:

Relative
rare disorder

Accumulation
of calcium salts in juxta articular soft tissue mass

Calcifying
bursitis, calcifying collagenolysis, hip stones

Radiologic
feature

Amorphous, cystic, and multilobulated
calcification located in a periarticular distribution

Fluid-fluid level due to calcium layering
(metabolic active lesion)

Erosion or osseous destruction by adjacent
soft-tissue masses is absent

 Bone scintigraphy: focal increased
accumulation.

MRI: variable heterogeneous signal intensity
(low signal: calcification within lesion, heterogeneous signals on T2WI: prominent
fluid/inflammatory components), septal enhancement: vascularized tissue
surrounding deposit of calcium salts.

References:

Imaging of soft
tissue tumors 2^nd edition, Lippincott Williams & Wilkins

RadioGraphics 2006; 26:871–885