Tumoral calcinosis: shoulder

Case contributed by Dr Ayaz Hidayatov

Presentation

40-year-old man with long standing end-stage renal disease presented with a two month history of an enlarging, painless right shoulder mass.

Patient Data

Age: 40
Gender: Male
MRI

The axial T1, axial, coronal and sagittal T2- weighted fat suppressed images of the shoulder reveal a periarticular, multilobulated mass with multiple fluid-fluid levels. The mass is well-demarcated, lobulated and contains layering “milk of calcium”, predominantly low signal on T1-weighted and T2-weighted sequences.

CT

Axial CT images of the right upper extremity show multilobulated giant soft tissue masses with multiple fluid-calcium levels.

There is no erosion or osseous destruction.

Case Discussion

Tumoral calcinosis is a rare clinical and histopathologic syndrome, characterized by lobular, calcified soft tissue masses that occur in periarticular locations, especially: the hip, elbow, shoulder, foot and wrist. The shoulder is the most commonly affected site.

Tumoral calcinosis is usually classified as primary (idiopathic or familial) or secondary. The primary form typically presents with periarticular soft tissue masses in the first or second decade of life.

The secondary form is associated mainly with chronic renal failure in hemodialysis patients, and has been attributed to secondary hyperparathyroidism.

This lesions are characterised by large, amorphous calcific densities that surround joints. In most cases, they demonstrate fluid / calcium levels (milk of calcium / hydroxyapatite crystals in suspension) (Sedimentation sign)

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Case information

rID: 52845
Case created: 22nd Apr 2017
Last edited: 24th Apr 2017
Inclusion in quiz mode: Included

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