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DOI: 10.1148/rg.263055099
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Right arrow Musculoskeletal Radiology

Tumoral Calcinosis: Pearls, Polemics, and Alternative Possibilities1

Kathryn M. Olsen, MD and Felix S. Chew, MD

1 From the Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1088 (K.M.O., F.S.C.); and the Department of Radiology, University of Washington, Seattle, Wash (F.S.C.). Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received April 21, 2005; revision requested May 19; final revision received August 15; accepted August 15. Both authors have no financial relationships to disclose.

Figure 1
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  		Figure 1a.  First published radiographs of tumoral calcinosis lesions. (a) Tumoral calcinosis of the hip. (b, c) Lateral (b) and anteroposterior (c) views show tumoral calcinosis of the elbow. (Reprinted, with permission, from reference 6.)

 

Figure 1
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  		Figure 1b.  First published radiographs of tumoral calcinosis lesions. (a) Tumoral calcinosis of the hip. (b, c) Lateral (b) and anteroposterior (c) views show tumoral calcinosis of the elbow. (Reprinted, with permission, from reference 6.)

 

Figure 1
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  		Figure 1c.  First published radiographs of tumoral calcinosis lesions. (a) Tumoral calcinosis of the hip. (b, c) Lateral (b) and anteroposterior (c) views show tumoral calcinosis of the elbow. (Reprinted, with permission, from reference 6.)

 

Figure 2
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  		Figure 2a.  Histopathologic features of tumoral calcinosis. (a) High-power photomicrograph shows a calcified mass in the center of the field with foreign body inflammatory reaction, giant cells, and surrounding fibrosis. (b) Low-power photomicrograph shows several calcified masses with chronic inflammatory and fibrotic encapsulation. (Reprinted, with permission, from reference 10.)

 

Figure 2
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  		Figure 2b.  Histopathologic features of tumoral calcinosis. (a) High-power photomicrograph shows a calcified mass in the center of the field with foreign body inflammatory reaction, giant cells, and surrounding fibrosis. (b) Low-power photomicrograph shows several calcified masses with chronic inflammatory and fibrotic encapsulation. (Reprinted, with permission, from reference 10.)

 

Figure 3
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  		Figure 3.  Tumoral calcinosis of the shoulder girdle. Anteroposterior radiograph shows multiple rounded calcified masses, some of which demonstrate sedimentation (arrows).

 

Figure 4
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  		Figure 4a.  Tumoral calcinosis of the greater trochanteric bursa. Anteroposterior (a) and frog lateral (b) radiographs show a multilobulated, rounded, calcified mass in the soft tissues.

 

Figure 4
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  		Figure 4b.  Tumoral calcinosis of the greater trochanteric bursa. Anteroposterior (a) and frog lateral (b) radiographs show a multilobulated, rounded, calcified mass in the soft tissues.

 

Figure 5
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  		Figure 5a.  CT appearance of tumoral calcinosis. (a) CT scan shows tumoral calcinosis of the greater trochanteric bursa. The tumoral calcinosis appears as cystic calcified lesions, some of which demonstrate sedimentation (arrows). (b) CT scan of another patient shows tumoral calcinosis lesions between the scapula and chest wall. The lesions appear predominantly homogeneous rather than cystic, an appearance suggestive of lower metabolic activity than that associated with the more cystic lesions in a.

 

Figure 5
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  		Figure 5b.  CT appearance of tumoral calcinosis. (a) CT scan shows tumoral calcinosis of the greater trochanteric bursa. The tumoral calcinosis appears as cystic calcified lesions, some of which demonstrate sedimentation (arrows). (b) CT scan of another patient shows tumoral calcinosis lesions between the scapula and chest wall. The lesions appear predominantly homogeneous rather than cystic, an appearance suggestive of lower metabolic activity than that associated with the more cystic lesions in a.

 

Figure 6
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  		Figure 6a.  MR imaging appearance of tumoral calcinosis. (a) Axial T1-weighted MR image shows tumoral calcinosis at the extensor surface of the elbow. The tumoral calcinosis appears as multiple rounded masses with low signal intensity. (b) Correlative CT scan shows the distribution and morphology of the lesions.

 

Figure 6
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  		Figure 6b.  MR imaging appearance of tumoral calcinosis. (a) Axial T1-weighted MR image shows tumoral calcinosis at the extensor surface of the elbow. The tumoral calcinosis appears as multiple rounded masses with low signal intensity. (b) Correlative CT scan shows the distribution and morphology of the lesions.

 

Figure 7
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  		Figure 7a.  Massive periarticular calcinosis in an adult woman with chronic renal disease. (a) Radiograph obtained at presentation shows an appearance indistinguishable from that of tumoral calcinosis. (b) Radiograph obtained 2 weeks after initiation of hemodialysis shows that the size of the calcification has diminished considerably. (Reprinted, with permission, from reference 41.)

 

Figure 7
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  		Figure 7b.  Massive periarticular calcinosis in an adult woman with chronic renal disease. (a) Radiograph obtained at presentation shows an appearance indistinguishable from that of tumoral calcinosis. (b) Radiograph obtained 2 weeks after initiation of hemodialysis shows that the size of the calcification has diminished considerably. (Reprinted, with permission, from reference 41.)

 

Figure 8
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  		Figure 8.  Calcinosis universalis in a 19-year-old man with proximal muscle weakness and a diagnosis of mixed connective tissue disease. Anteroposterior radiograph shows rounded, dense, amorphous calcifications around the left hip and thigh. Some calcifications are distributed in a sheetlike manner along the medial thigh muscles. (Artifacts were removed by using Photoshop [Adobe Systems, San Jose, Calif].) (Reprinted, with permission, from reference 42.)

 

Figure 9
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  		Figure 9.  Calcinosis universalis in a 26-year-old woman with dermatomyositis. Radiograph of the ankle shows amorphous, dense soft-tissue calcification distributed in vertical sheets following the fascial planes of the lower leg. No underlying bone or joint abnormality is present. (Reprinted, with permission, from reference 43.)

 

Figure 10
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  		Figure 10.  Calcinosis circumscripta in a 74-year-old woman with a long-standing history of CREST syndrome. Radiograph of the hand shows focal, dense, well-defined calcifications in the soft tissues of the distal thumb and index finger.

 

Figure 11
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  		Figure 11.  Calcific tendonitis in a 70-year-old man with acute pain and swelling over the dorsal aspect of the wrist. Lateral radiograph shows amorphous calcifications overlying the expected location of the extensor tendons of the wrist. (Reprinted, with permission, from reference 44.)

 

Figure 12
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  		Figure 12.  Synovial osteochondromatosis in a 24-year-old man with hip pain. Radiograph shows multiple small, dense, punctate calcifications involving the hip joint with secondary shallow erosions of the underlying femoral neck. (Reprinted, with permission, from reference 46.)

 

Figure 13
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  		Figure 13.  Synovial sarcoma in a young adult with a right buttock mass. Radiograph of the hip shows several dense, rounded calcifications overlying the greater trochanter. The noncalcified portion of the lesion extends superiorly from the femur to the lateral aspect of the iliac wing.

 

Figure 14
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  		Figure 14a.  Parosteal osteosarcoma in a 24-year-old woman with a posterior knee mass. Lateral (a) and anteroposterior (b) radiographs of the thigh show a densely ossified mass arising from the posterior cortex of the distal femur. (Reprinted, with permission, from reference 51.)

 

Figure 14
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  		Figure 14b.  Parosteal osteosarcoma in a 24-year-old woman with a posterior knee mass. Lateral (a) and anteroposterior (b) radiographs of the thigh show a densely ossified mass arising from the posterior cortex of the distal femur. (Reprinted, with permission, from reference 51.)

 

Figure 15
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  		Figure 15.  Extraskeletal osteosarcoma in a 24-year-old man with a hard inguinal mass. CT scan shows a well-demarcated ossified mass in the left rectus sheath. (Reprinted, with permission, from reference 52.)

 

Figure 16
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  		Figure 16.  Heterotopic ossification in a woman with an internally fixed fracture of the posterior acetabular wall after reduction of a traumatic fracture-dislocation of the posterior hip. Radiograph of the hip obtained 9 weeks after the trauma shows a mass of maturing bone in the posterior soft tissues. Note the emerging cortical and trabecular structure of the bone.

 

Figure 17
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  		Figure 17.  Tophaceous gout in a man with long-standing hyperuricemia. Radiograph of the foot shows radiopaque soft-tissue swelling at the great toe with underlying erosive changes of the adjacent osseous structures.

 

Figure 18
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  		Figure 18.  Calcific myonecrosis in a 62-year-old man with a remote history of leg trauma. Anteroposterior radiograph of the lower leg shows a large, well-marginated, ovoid calcification overlying the expected location of the anterior compartment. The bone changes are the result of chronic osteomyelitis, which also dates back to the initial episode of trauma.

 




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