Presentation
Withheld.
Patient Data
Massive bilateral conglomerate nodular calcifications appearing localized to the thoracic wall. There is no evidence of pulmonary fibrosis. Findings are long-term stable over 10 years.
Dystrophic soft tissue calcifications around the right elbow joint.
Heterogeneous FDG uptake alongside soft tissue calcifications disseminated throughout the body, for example at the posterior right chest wall, periarticular region at the left elbow, and more predominantly at the thighs bilaterally. No specific muscle uptake to suggest muscle inflammatory changes. No convincing evidence of FDG-avid malignancy.
Case Discussion
There is a broad differential diagnosis for intrathoracic calcifications. In order to narrow down the list, one must assess (1) the location (parenchymal, pleural-based, mediastinal or chest wall) and (2) if parenchymal, whether they are focal or diffuse.
In this particular case, intraparenchymal parasitic etiology was initially considered based on the intrathoracic calcifications but over the years, the patient developed symmetrical soft tissue dystrophic calcifications in the bilateral upper and lower limbs. FDG-PET suggested active disease at the sites of calcinosis without signs of malignancy. The patient finally underwent a skin biopsy confirming dermatomyositis.
Case contributed by Dr Josephine Pressacco.