Soft Tissue Calcifications



Soft Tissue Calcifications


Christopher G. Anton, MD,



DIFFERENTIAL DIAGNOSIS


Common



  • Venous Malformation


  • Heterotopic Ossification (HO)



    • Myositis Ossificans Circumscripta (MO)


  • Dermatomyositis (DM)


Less Common



  • Other Collagen Vascular Diseases


  • Neoplastic


Rare but Important



  • Metabolic/Hypercalcemia


  • Ehlers-Danlos


  • Parasitic


  • Tumoral Calcinosis


  • Myositis Ossificans Progressiva


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Venous Malformation



    • Present at birth and grows proportional to child


    • MR



      • Lack of high-flow vessel on GE imaging


      • Phleboliths or thrombi


      • Diffuse contrast enhancement


  • Heterotopic Ossification (HO)



    • HO and MO in literature are commonly used interchangeably



      • But MO is subtype of HO


    • HO: Lamellar bone inside soft tissue (ST) structures where bone does not exist



      • MO: When HO occurs within muscles or ST


    • Ectopic calcification differs from MO: Mineralization of ST as result of chemical or physical trauma



      • Calcification deposits rather than bone formation


    • MO: Most commonly in arms or in quadriceps of thighs


    • HO: Adjacent to large joints



      • 1-4 months (up to 18 months) following injury


    • HO



      • Trauma: Spinal fusion, total hip arthroplasty, intraoperative fixation of acetabular fracture, burns, etc.


      • Neurogenic: Spinal cord injury, CNS tumors, CNS infections, MS, etc.


      • Myositis ossificans progressiva: Rare


    • MO



      • Radiographically calcifications are seen at 4-6 weeks following injury


      • Bone scan (BS) used for earliest detection


      • BS: Positive 2-6 weeks earlier than ossification is visible on radiographs


      • BS: Early in course, only blood pool images may be positive whereas abnormal uptake during soft tissue phase is seen later


      • NECT: Used for osseous architecture


      • Mature phase; well-defined calcified mass with internal fat marrow


    • Alkaline phosphatase is commonly elevated up to 3.5x normal with peak at ˜ 12 weeks following injury


  • Dermatomyositis (DM)



    • Collagen vascular disease


    • Gottron papules and heliotrope rash are pathognomic


    • Bimodal age distribution (seen at any age)



      • Peak: 40-50 years old


      • Children: 5-14 years old


    • Calcifications in 1/4 to 1/2; typically seen 6 months to 3 years after onset of disease



      • Typically elbows, knees, digits, and extremities


    • 5 major criteria for diagnosis of DM



      • Symmetric muscle weakness


      • Characteristic changes on muscle biopsy


      • Increased muscle enzymes in serum


      • EMG abnormality of myopathy and denervation


      • Characteristic skin rash


Helpful Clues for Less Common Diagnoses



  • Other Collagen Vascular Diseases



    • Scleroderma



      • Anywhere can be affected


      • Most commonly fingers and extremities; usually extensor side of forearms and prepatellar ST


    • Polymyositis, SLE, CREST syndrome


  • Neoplastic



    • Synovial sarcoma



      • Calcifications in 1/3


      • Age: 15-35 years old


      • Typically adjacent to joints and tendon sheaths


    • Lipoma, infantile myofibromatosis, etc.



Helpful Clues for Rare Diagnoses

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Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Soft Tissue Calcifications

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