Presentation
Long standing end-stage renal disease presented with a two month history of an enlarging, painless right shoulder mass.
Patient Data
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.
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.
These lesions are characterized 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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