Premature Calcifications of Costal Cartilages: A New Perspective

Walter Rhomberg,Antonius Schuster

doi:10.1155/2014/523405

Abstract

Background. Calcifications of the costal cartilages occur, as a rule, not until the age of 30 years. The knowledge of the clinical significance of early and extensive calcifications is still incomplete. Materials and Methods. A search was made to find patients below the age of 30 years who showed distinct calcifications of their lower costal cartilages by viewing 360 random samples of intravenous pyelograms and abdominal plain films. The histories, and clinical and laboratory findings of these patients were analyzed. Results. Nineteen patients fulfilled the criteria of premature calcifications of costal cartilages (CCCs). The patients had in common that they were frequently referred to a hospital and were treated by several medical disciplines. Nevertheless many complaints of the patients remained unsolved. Premature CCCs were often associated with rare endocrine disorders, inborn errors of metabolism, and abnormal hematologic findings. Among the metabolic disorders there were 2 proven porphyrias and 7 patients with a suspected porphyria but with inconclusive laboratory findings. Conclusion. Premature CCCs are unlikely to be a normal variant in skeletal radiology. The findings in this small group of patients call for more intensive studies, especially in regard to the putative role of a porphyria.

Highlights

The calcification of the costal cartilages follows genderrelated patterns and is generally not evident radiographically until after the age of 30 years [1]
We collected the clinical data of 14 patients with premature calcifications of costal cartilages (CCCs), but we felt at that time the data were somewhat inconclusive, and so we did not submit them for publication
A renewed interest was triggered by the detection of a case of porphyria associated with glioblastoma multiforme [13] due to the finding of extensive CCC and our recall of suspected porphyrias in relation to CCC found in that earlier investigation

Summary

Introduction

The calcification of the costal cartilages follows genderrelated patterns and is generally not evident radiographically until after the age of 30 years [1]. There have been descriptions of an association of premature calcifications with hyperthyroidism [5, 6], corticosteroid medication [7], and rare congenital diseases such as adrenogenital syndrome [8, 9] or Keutel syndrome [10, 11], but some authors regard even extensive costal cartilage calcifications (CCC) as a normal finding or variant [12]. Nineteen patients fulfilled the criteria of premature calcifications of costal cartilages (CCCs). Premature CCCs are unlikely to be a normal variant in skeletal radiology The findings in this small group of patients call for more intensive studies, especially in regard to the putative role of a porphyria

Objectives

Methods

Results

Conclusion