Multiple Calcifications Research Articles

Synovial Chondromatosis of the Sub- Scapular Bursa

A 42-year-old housewife was admitted to our clinic because of shoulder pain. At X-ray and CT, multiple calcifications and ossifications were seen in the subscapular bursa and glenohumeral joint. MRI findings were consistent with synovial chondromatosis. Surgical treatment was planned but the patient refused. Thus conservative treatment was initiated for pain relief. The shoulder joint is a rare localization in this disorder. Although our patient’s symptoms resolved with conservative treatment, we think that it would be better to perform surgical treatment because of the increased size and number of loose bodies and minimal or moderate chondral damage.

Multiple Intracranial Calcifications as a Complication of External Ventricular Drain Placement

The authors present a case of multiple intracranial calcifications after the procedure of external ventricular drain placement in a 50-year-old man with pericallosal artery aneurysm. We believe that calcifications formed dust that had fallen into the track during the external ventricular drain procedure. The clinical features and radiological findings are presented with review of literature.

Giant Synovial Chondromatosis of the Knee Mimicking a Parosteal Osteosarcoma: A Case Report

Synovial chondromatosis is a benign nodular cartilaginous proliferation arising in the synovium of joints. Usually the major weight bearing joint is involved and approximately 70% of cases are the knee joint. The radiolographic features of this condition are variable. Classically, radiographs reveal multiple intraarticular calcifications of similar size and shape, distributed throughout the joint, with typical “ring-and-arc” chondroid mineralization. The classic appearance is not often encountered. Rarely, it would be confused with malignancy such as chondrosarcoma, osteosarcoma or synovial sarcoma. We report a case of primary synovial chondromatosis originating from the intra-articular tissues of the knee, mimicking a parosteal osteoarcoma with the clinical, radiographic and computed tomography (CT) findings.

Calcinosis cutis in a patient with systemic lupus erythematosus

We present the case of a 36 year old woman with systemic lupus erythematosus with hematological, skin and joint affection, with an onset 21 years prior. The immunologic study showed positive ANA (titer 1:1,000, homogeneous pattern), anti-DNA, anti-ENA and anti-Ro (SSA). She presented multiple hard subcutaneous nodules on the trunk and extremities since 10 years prior, which tended to conglomerate at the buttocks, hips and thighs forming extensive plaques. Throughout the last year she has presented a progressively larger ulcer with a serous exudate over the lesions of the right thigh. Cultures were positive for Staphylococcus aureus. A simple abdomen x-ray (Figure 1) and a tomography (Figure 2) revealed multiple and extensive subcutaneous calcifications (arrows). In spite of treatment with diltiazem, calcifications persist and the ulcer progressed rapidly. Diagnosis: calcinosis cutis

Second Reactivation of Neurocysticercosis: A Case Report

Neurocysticercosis is a relatively common parasiticdisease involving the central nervous system.Neurocysticercosis is characterized by multiple calcifiedlesions in the brain, like as occurs in patients with tuber-culosis. Neurocysticercosis is thought not to undergo re-activation. We report here on the first case of twice-reac-tivated neurocysticercosis. Case ReportA 59-year-old man sought evaluation at our hospitaldue to perioral paresthesias and dysarthria on 25 April2009. In 1997, he was admitted to our hospital due toheadaches and seizures of 1 week duration. He had ex-perienced intermittent seizures since 1991. On the brainmagnetic resonance imaging (MRI), there were multipledark signal intensity lesions that were suggestive of cal-cifications in both cerebral hemispheres and peripheral-enhancing cystic lesions in both frontal lobes. A dot-like,high signal intensity on the T1-weighted image and alow signal intensity on T2-weighted image were notedin the right frontal lobe, suggesting a scolex of cysticer-cosis (images not shown). Positive results were reportedon the serum and cerebrospinal fluid (CSF) cysticercosisenzyme-linked immunosorbant assay (ELISA) tests (0.32and 0.68, respectively). He was diagnosed with neuro-cysticercosis and treated with an anti-helminthic (biltri-cide). He recovered completely and was discharged. In 2001, the patient had complaints of headaches,dizziness and numbness in both arm and legs. On brainCT, there were multiple nodular calcifications in bothcerebral hemispheres and no abnormal enhancing le-sions (Figs. 1A, B), and this was all compatible with end-stage neurocysticercosis. He was hospitalized for severaldays and he improved. In 2002, he was admitted to ourhospital with dysarthria and focal seizures of the lip sev-eral times during 1 day. There were no significant re-sults on the serum and CSF cysticercosis ELISA tests.Thick bands of peripheral enhancement of multiplenodular calcified lesions and surrounding edema werenoted on the brain MRI (Figs. 1C, D). The patient ap-peared to have reactivated neurocysticercosis and hewas treated with the anti-helmintic praziquantel. His

Leukoencephalopathy with intracranial calcifications and cysts in an adult: Case report and review of literature

Leukoencephalopathy, intracranial calcifications, and cysts (LCC) is a very rare cerebral disorder, first described in 3 children in 1996. It has subsequently been reported in adults and children from Europe and America, but has not so far been reported from Asia. We report an adult patient with pathologically proven LCC from a tertiary care hospital in South India. He presented with features of ataxia and raised intracranial pressure. Magnetic resonance imaging of the brain showed multiple bilateral cerebral cystic lesions along with diffuse white matter lesions in the cerebral and cerebellar white matter, and computed tomography of brain showed multiple calcifications in the white matter and basal ganglia. A large right cerebellar cyst causing mass effect was surgically excised. Histopathologic features were consistent with earlier reports of LCC and showed Rosenthal fibers, angiomatous changes, and calcifications. Our report suggests that although it is rare, LCC has a global distribution.

Arthroscopic Treatment of Localized Synovial Chondromatosis of the Posterior Knee Joint

Synovial chondromatosis is an uncommon, benign neoplastic process typically affecting adult men and most commonly involving the knee, hip, and elbow joints. Intra-articular primary synovial chondromatosis in the knee joint may be localized or generalized. The symptoms associated with localized synovial chondromatosis may include diffuse pain, swelling, restricted motion, crepitus with symptoms of locking and giving way, and posteromedial tenderness mimicking medial meniscus tear. Diagnosis is usually established with magnetic resonance imaging (MRI) and confirmed by histological examination. To our knowledge, synovial chondromatosis of the knee joint in the posteromedial corner has not been reported in the literature.

Metastatic Squamous Cell Carcinoma Presenting as Diffuse and Punctate Cervical Lymph Node Calcifications

The purpose of this series was to show the sonographic appearance of calcified cervical lymph nodes and the utility of sonographically guided fine-needle aspiration biopsy (FNAB) in the setting of metastatic squamous cell carcinoma (SCC). Two cases of confirmed metastatic SCC to cervical lymph nodes were identified. Sonography and sonographically guided FNAB were performed in both cases with positron emission tomography (PET)/computed tomography (CT) correlation. In case 1, sonography identified a diffusely calcified, avascular cervical lymph node. Positron emission tomography/CT suggested granulomatous disease as a cause for hypermetabolism; however, sonographically guided FNAB identified metastatic SCC. In the second case, FNAB initially performed without sonographic guidance did not show malignancy. Subsequent FNAB with sonographic guidance identified an abnormal cervical lymph node with focal calcifications and internal color Doppler flow. Metastatic SCC was diagnosed on histopathologic examination. Subsequent PET/CT confirmed multiple punctate calcifications in a hypermetabolic lymph node. Calcifications in cervical lymph nodes from metastatic SCC are very rare. These 2 cases show the variable sonographic appearances and the utility of sonographically guided FNAB in establishing the correct diagnosis.

Desmoplastic nested spindle cell tumor of the liver in an adult

Desmoplastic spindle cell tumor of the liver is a recently described and extremely unusual neoplasm that affects children and young adults. We report 1 case in a 33-year-old man. The patient had abdominal pain and dyspepsia. Abdominal examination showed that the liver was enlarged and palpable until umbilical region. Laboratory studies demonstrated positive serologic markers to hepatitis B virus. All other analytical studies were irrelevant. Computed tomography revealed a large tumor mass in left hepatic lobe showing heterogeneous densities, with hyperdense peripheral areas, as multiple nodular calcifications of less than 1 cm. In the central part of the mass, a big hypodense area was observed. There was no evidence of extrahepatic disease. Grossly, the tumor was well circumscribed with multiple nodular calcifications. The tumor was characterized by the presence of cohesive nests of bland spindle cells arranged in short fascicles and surrounded by desmoplastic stroma, intermixed with epithelioid cells. Mitotic activity was very low. Extensive osteoid formation was seen inside the cell nests. The tumor cells showed cytoplasmic reactivity for vimentin and pan-cytokeratin. The cells of desmoplastic stroma were immunoreactive for actin. The biologic behavior is still uncertain with only 5 published cases, but current information suggests that they are low-grade tumors with an indolent course. The clinical and morphologic features of this tumor are very similar to those of tumors previously reported as "nested stromal-epithelial tumor of liver" and "ossifying stromal-epithelial tumor of liver." We describe the histologic, immunohistochemical, and molecular genetic features of a case of desmoplastic spindle cell tumor of the liver and review the literature.

A premature infant with fetal myocardial and abdominal calcifications and factor V Leiden homozygosity

We present a premature male neonate with confirmed factor V Leiden deficiency diagnosed prenatally with cardiac and abdominal calcifications. Our patient's findings suggest that clinicians consider thromboembolic conditions when multiple fetal calcifications are visualized.

A Rare Case of Pancreas Divisum in a Patient with Hereditary Pancreatitis

Purpose: Pancreas divisum, which occurs in about 7-10% of the population, results from a developmental failure in the fusion of the dorsal and ventral ducts of the pancreas. It is associated with an increased incidence of pancreatitis in up to 5% of patients. We present a rare case of pancreas divisum in a patient with hereditary pancreatitis. A 12-year-old female with no other medical history presented to the pediatrics GI clinic after recurrent hospital admissions for abdominal pain, nausea, and vomiting since age 3. Her parents reported that she had been given the diagnosis of acute pancreatitis on different occasions, and had received only supportive care. Her family history was significant for several paternal family members with pancreatitis. Abdominal CT and MRI from 2 years prior to clinic visit revealed an irregular and dilated pancreatic duct, with multiple calcifications throughout the pancreas. An ERCP with pancreatogram showed a small, short ventral pancreatic duct. The minor papilla was then cannulated, and pancreatogram revealed a dilated dorsal pancreatic duct. A papillotomy was performed on the minor papilla, and a 7 Fr × 7 cm plastic stent was placed. Laboratory work up revealed no mutations in the CFTR gene. The PRSS1 gene had the N291 mutation on exon 3. It is one of the most common mutations found in patients with hereditary pancreatitis, and is associated with mild or asymptomatic disease. A novel variation was found in the SPINK1 gene, Q68R on exon 4. The patient had several ERCPs for stent change with symptomatic relief. However, symptoms would recur and further hospital admissions were required. Diabetes mellitus also developed as a complication of chronic pancreatitis. She will be evaluated by surgery for a possible sphincteroplasty vs. pancreaticojejunostomy. Patients with recurrent acute exacerbations and pain as their main complaint typically benefit from surgical intervention if they have had good response to previous pancreatic duct stenting. Only one previous case of pancreas divisum in a patient with hereditary pancreatitis has been reported in the literature.

A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism.

Physiological intracranial calcification occurs in about 0.3-1.5% of cases. It is asymptomatic and detected incidentally by neuroimaging. Pathological basal ganglia calcification is due to various causes, such as: metabolic disorders, infectious and genetic diseases. Hypoparathyroidism and pseudohypoparathyroidism are the most common causes of pathological basal ganglia calcification. Besides tetany and seizures this condition is presented by parkinsonism and dementia. Such parkinsonism does not respond to drugs containing levodopa. Infections (toxoplasmosis, rubella, cytomegalovirus, cysticercosis, AIDS) give multiple and asymmetric intracranial calcification. Inherited and neurodegenerative diseases cause symmetrical, bilateral basal ganglia calcification which is not related to metabolic disorders. Since adequate treatment of hypoparathyroidism may lead to marked clinical improvement, serum concentration of calcium, phosphorus, and parathyroid hormone (PTH) is suggested to be determined in all individuals with calcification of the basal ganglia to rule out hypoparathyroidism.

Carney complex: A clinicopathologic and molecular biological study of a sporadic case, including extracutaneous and cutaneous lesions and a novel mutation of the PRKAR1A gene

Carney complex (CNC) is an autosomal dominant disorder associated with multiple neoplasms. We report a case of a 40-year-old Caucasian man with a sporadic form of CNC. This is a clinicopathologic description and molecular biological study with an emphasis on histopathologic findings. The patient presented with multiple cutaneous myxomas, cardiac myxomas, and spotty pigmentation at typical sites. Additionally, a blue nevus, a lipoma, multiple calcifications in both testes, and hypoechogenic areas suspected of being adenomas in the thyroid gland were found. Microscopically, the 2 cardiac and 6 cutaneous myxomas studied manifested a typical appearance, being composed of scattered polygonal, stellate, plump and/or spindle cells in a mucinous matrix containing small, sometimes dilated blood vessels. Of the 6 cutaneous myxomas, only in one lesion was there an abnormal epithelial component (tiny basaloid buds and a horn cyst). Molecular biologic study revealed a heterozygous shift mutation c.796dupA in exon 10 of the PRKAR1A gene. Physical examination and genetic testing of family members (both parents and two brothers) for the PRKAR1A mutation were negative, as was analysis of the peripheral blood of 110 randomly selected, unrelated healthy individuals for the above mutation. These findings suggest sporadic disease and a novel mutation in our patient. None. Herein we report a case of sporadic CNC in which a novel mutation in PRKAR1A was identified.

Multiple bilateral spinal nerve root calcifications in Charcot‐Marie‐Tooth disease

We present a patient with Charcot-Marie-Tooth disease with multiple bilateral symmetrical cervical nerve root calcifications. To our knowledge, such a finding has not been described in the literature in association with this disease. We propose that multiple bilateral symmetrical spinal nerve root calcifications may be an additional imaging feature, possibly diagnostic, in this hereditary motor and spinal neuropathy.

Showered Calcific Emboli to the Brain, the ‘Salted Pretzel’ Sign, Originating From the Ipsilateral Internal Carotid Artery Causing Acute Cerebral Infarction

Unenhanced head CT has become the first line imaging study in the evaluation of suspected acute cerebral ischemia. It is important to identify subtle findings of acute ischemia on this exam to direct appropriate patient management. Summary of Case- We report the first case of multiple pial surface distal internal carotid artery territory calcified emboli causing multifocal cerebral infarctions, likely from a carotid bifurcation source. Visualization of multiple pial surface calcifications on unenhanced head CT, the 'salted pretzel sign', should raise suspicion for acute infarction from showered calcific emboli.

Multiple splenic calcifications

Multiple splenic calcifications

Renal arterial branch calcification mimicking renal calculi in ultrasonography

The calcifications in the renal sinus are often due to renal calculi and occasionally due to gas. Calcifications of the branches of the renal artery coursing through the sinus may be mistaken for renal calculi in some rare instances, resulting in a misdiagnosis. All hyperechoic or echogenic foci in the renal medulla are not caused by stones. Renal stones and gas are the commonly reported echogenic foci in the sinus region. However, in rare cases, the calcified vessel walls of renal arterial branches coursing through the sinus and renal parenchyma may be mistaken for renal calculi. We report herein one such observation. A middle-aged woman diagnosed with diabetic nephropathy and hypertension presented with symptoms of urinary tract infection. Ultrasound of the abdomen revealed multiple calcifications at the junctional region of the sinus echoes and the medulla in both the kidneys [Figure 1]. Although the calcifications were initially interpreted as renal stones, in view of their unconventional anatomical location, the patient was further subjected to Doppler ultrasonography and plain computed tomography which revealed the presence of calcification in the segmental and interlobar arteries, which was mistaken to be stones [Figure 2]. During their course through the sinomedullary region, calcified branches of the renal artery, such as the segmental, interlobar, and arcuate arteries, may mimic nephrolithiasis[1] in ultrasonographic imaging. In such a situation, a Doppler study is helpful in demonstrating the actual origin of calcification from the vessel wall to be distinct from the curvilinear appearance of calculi.[2] A noncontrast CT study will also help to confirm the exact origin of calcification when it is observed in renal artery branches. Figure 1 Ultrasound image of the left kidney showing echogenic foci in the renal sinus region (marked with open arrow) Figure 2 Unenhanced computed tomography showing multiple calcific densities in the segmental renal artery and in its branches on both sides We present here one such observation wherein an initial misdiagnosis of renal stone disease was later corrected to be renal calcification secondary to vascular calcification.

Extensive meningeal and prenchymal calcified tuberculoma as long-term residual sequelae of tuberculous meningitis

A 51-year-old woman presented with progressive cognitive decline of 1 year duration. Her past medical history revealed that she received treatment for tuberculous meningitis and milliary tuberculosis at the age of twenty. At that time cerebrospinal fluid (CSF) and sputum were positive for M. tuberculosis. During that illness she had suffered from recurrent seizures. Neurological examination revealed right optic atrophy with total blindness and right spastic hemiparesis. Neuropsychological tests revealed visuospatial, verbal and visual memory deficits, and also deficits in frontal executive functions. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed multiple extensive popcorn-like calcifications in the basal cisterns, insula, hippocampus, and frontal corticomedullary junction along the meninges protruding into the brain prenchyma [Figures 1 and 2]. The masses showed hypointensity in all spin-echo sequences of the brain MRI [Figure 2]. These findings suggest extensive meningeal and parenchymal calcified tuberculoma as long-term sequelae of tuberculous meningitis. A large calcified nodule in the right crus cerebri was probably responsible for the blindness in her right eye and a right hippocampal head compression by the calcified lesion may relate to some of her cognitive deficits [Figure 3].

Identification of calcification with MRI using susceptibility‐weighted imaging: A case study

Susceptibility weighted imaging (SWI) is a new MRI technique that can identify calcification by using phase images. We present a single case with a partially calcified oligodendroglioma, multiple calcified cysticercosis lesions, and multiple physiologic calcifications in the same patient. SWI phase images and computed tomography (CT) images are compared. SWI phase images showed the same calcified lesions as shown on CT and sometimes some new calcifications. Our conclusion is that SWI filtered phase images can identify calcifications as well as CT in this case.

Association of renal function with cardiac calcifications in older adults: the cardiovascular health study

Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are highly prevalent in patients with end-stage renal disease. It is less well established whether milder kidney disease is associated with cardiac calcifications. We evaluated the relationships between renal function and MAC, aortic annular calcification (AAC) and AVS in the elderly. From the Cardiovascular Health Study, a community-based cohort of ambulatory adults >or= age 65, a total of 3929 individuals (mean +/- SD age 74 +/- 5 years, 60% women) were evaluated with two-dimensional echocardiography. Renal function was assessed by means of creatinine-based estimated glomerular filtration rate (eGFR) and cystatin C. The prevalences of MAC and AAC were significantly higher in individuals with an eGFR < 45 mL/ min/1.73 m(2) (P < 0.01 for each), and cystatin C levels were significantly higher in individuals with MAC or AAC compared to individuals without these cardiac calcifications (P < 0.001 for each). After multivariate-adjustment, an eGFR <45 mL/min/1.73 m(2) was significantly associated with MAC [odds ratio 1.54 (95% CI 1.16-2.06), P = 0.003] and not associated with AAC [1.30 (0.97-1.74), P = 0.085] and AVS [1.15 (0.86-1.53), P = 0.355]. In addition, cystatin C levels were independently associated with MAC [odds ratio per SD 1.12 (1.05-1.21), P = 0.001] and not associated with AAC [1.07 (1.00-1.15), P = 0.054] and AVS [0.99 (0.93-1.06), P = 0.82]. Furthermore, the prevalence of multiple cardiac calcifications was higher in subjects with an eGFR < 45 mL/ min/1.73 m(2) and increased per quartile of cystatin C (P-values < 0.001). In addition, a significant trend was observed between an eGFR < 45 mL/min/1.73 m(2), increasing levels of cystatin C and the number of cardiac calcifications (P < 0.05). In a community-based cohort of the elderly, moderate kidney disease as defined by an eGFR <45 mL/min/1.73m(2) and elevated levels of cystatin C was associated with prevalent MAC. In addition, a significant trend was observed between an eGFR <45 mL/min/1.73m(2), increasing levels of cystatin C and the number of cardiac calcifications. No associations were found between renal function and AAC or AVS.