Presentation
Bed-ridden and pain in the hip, thigh, and groin for 4 weeks
Patient Data
Extensive tumoral calcinosis related to patient's long standing history of scleroderma. The bones are demineralized. There is a subacute subtrochanteric fracture of the right femur that is displaced and angulated with a lateral apex. There is no evidence of pathologic lesion at the fracture site. There is mild degenerative changes of the right hip joint.
A biopsy was performed of the femur fracture site to rule out malignancy prior to moving forward with internal fixation.
Pathology: right femur, frozen section - bone with medullary replacement by calcific material resembling tumoral calcinosis (calcific myelitis).
1 year following open reduction internal fixation of the right femur:
The fixation rod and screws are well seated and intact. The tumoral calcinosis is more severe in comparison to her images prior to the operation, demonstrated by additional calcific growths near the right pubic arch and pelvic rim.
The right lower thigh and knee are also affected by numerous calcific growths, affecting the soft tissues and bone.
The bones are demineralized. There are mild degenerative changes of the right hip and knee.
Case Discussion
The patient has a long standing history of systemic scleroderma. The pathology report on a biopsy of her right femur showed characteristics of tumoral calcinosis. This process lead to aberrancy in her bone architecture, loss of bone density, and predisposed her to femoral fracture.
This case was submitted with supervision and input from:
Ronnie Sebro M.D., Ph.D (Attending Radiologist) & Kati Bullock M.D. (Resident Radiologist)
Mayo Clinic, Jacksonville
Department of Diagnostic Radiology
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