SOFT TISSUE CALCIFICATION
These are listed below in order of prevalence.
(Note: Do not confuse soft tissue calcification with bone calcification. Bone calcification will be dealt in Bone Tumour Radiology)
Types of soft tissue calcification
1. Dystrophic Calcification
2. Metastatic Calcification
3. Calcinosis
4. Chondrocalcinosis
5. Synovial Chondromatosis.
Dystrophic calcification
Calcification in damaged or degenerating tissue by small to large amorphous calcium deposit.
Not associated with metabolic disorder.
Almost every calcification that one sees in the soft tissues in actual radiographic practice is due to dystrophic calcification.
They have a prevalence of 95-98% out of all soft tissue calcification.
Differential diagnosis of dystrophic calcification
Mnemonic = VINDICATE (VINDAT)
V = Venous - Phlebolith
I = Infection - Cysticercosis
N = Neoplasm - Osteosarcoma
D = Drugs - Vitamin D overdose
A = Autoimmune - Dermatomyositis
T = Trauma - Hematoma, Heterotopic ossification
Vascular calcification - Phlebolith in the pelvic vein with characteristic central lucency
Cysticercosis - Patient with multiple "rice grain" calcifications which are oriented along the direction of the muscle fibers.
A child with conventional intramedullary osteosarcoma of distal femur.
Hypervitaminosis D - Calcification over the elbow
Dermatomyositis-46 year old female with dermatomyositis and extensive soft tissue calcifications about the knee and hip.
Calcified hematoma - an example of dystrophic calcification
Dystrophic calcification of Achilles tendon due to recurrent trauma and tendinitis.
Heterotopic ossification of the right hip in a patient who sustained head injury
Metastatic Calcification
Calcification of normal tissue.
Frequently associated with a metabolic disorder.
Can result from any process with an elevated calcium-phosphate product.
Entities such as renal failure, hyperparathyroidism, sarcoidosis, milk-alkali syndrome, etc. can lead to metastatic calcifications.
These are often fine and diffuse throughout the soft tissues.
Metastatic calcification of the lung secondary to chronic renal disease and hyperparathyroidism.
Calcinosis
Calcification of cutaneous, subcutaneous or deep connective tissue.
Not associated with metabolic disturbance.
May be associated with with collagen-vascular disease.
3 Types:
1. Calcinosis circumscripta
2. Calcinosis universalis
3. Tumoral calcinosis
Calcinosis circumscripta (localized deposition of calcium in small in subcutaneous tissue) in Scleroderma
Calcinosis universalis - Diffuse cutaneous, subcutaneous and sometimes muscular calcification seen in dermatomyositis
Tumoral Calcinosis
Tumoral calcinosis is a relatively rare disorder most commonly seen in people of African descent.
The etiology is uncertain.
The histologic appearance is characterized by densely loculated masses of calcific debris and fluid enclosed by fibrous tissue.
Lesions grow quite slowly and rarely cause pain unless there is nerve involvement.
Surgical removal is the treatment of choice.
Incomplete resection leads to recurrence.
Tumoral calcinosis in a 59 year old black woman who presented with hip pain
Elderly female with tumoral calcinosis of the hand and wrist.
Same elderly female with tumoral calcinosis of both hip joint.
Chondrocalcinosis
Calcium pyrophosphate dihydrate deposition disease (CPPD) is usually associated with chondrocalcinosis.
This typically appears as a fine white line overlying the hyaline articular cartilage.
CPPD is also associated with calcifications in the soft tissues of the spine.
Chondrocalcinosis of the articular and fibrocartilage of the left knee in a patient with calcium pyrophosphate dihydrate deposit
Synovial chondromatosis
Affects knee, hip and shoulder joint.
Tends to be mono-articular.
Due to metaplasia of synovial connective tissue.
Uncommon cause of loose bodies.
Biopsy shows active synovial proliferation.
Synovial osteochondromatosis in a 24-year-old man with hip pain. Radiograph shows multiple small, dense, punctate calcifications
Synovial chondromatosis of shoulder
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Reader Feedback
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Reply
- KMLIAU KMLIAU Jul 24, 2009 @ 7:59 am | in reply to luiz carlos
- first of all, we need to ascertain what type of calcification is that. if u could send your x-ray images that would be very helpful.
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Reply
- luiz carlos luiz carlos Jul 23, 2009 @ 6:09 pm
- have calcification in my neck what medication i can take
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