Calcified failed renal transplant mimicking a cartilaginous tumor on radiograph
Presentation
End-stage renal failure on hemodialysis. History of left bipolar hemiarthroplasty for previous neck of femur fracture. Currently, having left thigh pain and weakness for few months.
Patient Data
Evidence of left femoral implant. Bony lucency seen surrounding the cemented femoral stem. No implant fracture.
Rings and arcs calcifications seen at the region of left iliac wing suspicious of a cartilaginous tumor.
Soft tissue lesion with multiple coarse calcifications within seen at the left extraperitoneal pelvis adjacent to the left external iliac vessels at the left iliac fossa, likely corresponding to the left iliac wing calcified lesion seen on the radiograph.
Diffuse osteopenia of the pelvic bones with prominent trabeculae. No suspicious bony lesion, particularly in the left ilium.
Evidence of left hip bipolar hemiarthroplasty causing streak artefacts. There is bony lucency surrounding the cemented femoral stem, measuring up to 3mm in maximum thickness at the proximal posteromedial aspect. No acute fracture. Mild heterotopic ossifications. Left acetabulum is preserved.
Alternating endplate sclerotic bones in the visualized lumbosacral spine suggestive of rugger-jersey spine due to renal osteodystrophy.
Enlarged and lobulated uterus. Urinary bladder is empty. No free fluid.
Case Discussion
The left iliac fossa extraperitoneal calcified lesion was projected over the left ilium on the pelvic radiograph giving the appearance of a suspicious left iliac cartilaginous tumor. On further history taking, the patient revealed that she had a previous renal transplant nearly 30 years prior which failed 20 years ago. She is currently on hemodialysis.
Failed renal transplants are often left in situ and may have various appearances on imaging. They may also develop dystrophic calcifications causing diagnostic confusion on radiographs and CT.1-3
In this patient, peri-implant lucency of greater than 2 mm is concerning of implant loosening and may account for her symptoms of thigh pain.
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