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PubMed1997

Metastatic pulmonary calcification after renal transplantation.

Metastatic pulmonary calcifications, unlike dystrophic calcifications, occur in the normal healthy lung. The radiological pattern is quite specific. The disease is commonly described in chronic renal failure with calcium disorders. The prognosis is totally unpredictable. In 1992, a 50 yr old man underwent a successful renal transplantation during the final stage of chronic renal failure. He subsequently developed asymptomatic diffuse nodular opacities, that were discovered in 1995. An open lung biopsy confirmed the diagnosis of metastatic pulmonary calcification. There was no calcium disorder in this patient. In contrast to the benign course of pulmonary calcification in most patients, some fulminant pulmonary calcifications complicating renal transplantation or hypercalcaemia have been described. Radiographic identification of such entities is important to permit correction of calcium disorders. Otherwise, the condition is a potentially progressive and fatal cause of respiratory failure.

Calcinosis↗

PubMed2004

Adult Wilms' tumor with calcification untreated for 5 years--a case report.

BACKGROUND: Wilms' tumor is rarely found in adults and there are no established treatment guidelines for such tumors in adults. Whereas calcification is a common finding in neuroblastoma, it is considered uncommon in Wilms' tumor. CASE PRESENTATION: We report a case of adult Wilms' tumor with calcification in a 22-year-old man. He had been initially referred to our hospital with a chief complaint of right flank pain 5 years previously, when abdominal computed tomography had revealed focal calcification at the upper pole of the right kidney. Although we planned further assessment, he did not revisit our hospital again until 5 years later, again because of right flank pain. Ultrasound and computed tomography scan revealed a large mass lesion with calcification in the right kidney, invasive to the hepatic lobe. The patient underwent curative right nephrectomy and partial right hepatic lobectomy. Pathological analysis demonstrated a nephroblastoma (Wilms' tumor) with predominant epithelial histology infiltrating the hepatic lobe. The patient has been well without tumor recurrence for 15 months after surgery. CONCLUSIONS: Calcification may be a sign of slow tumor growth and possibly a favorable prognosis in cases of adult Wilms' tumor.

Adolescent↗

PubMed2006

Dystrophic calcification and infraclavicular brachial plexopathy: case report.

OBJECTIVE: Dystrophic calcification refers to heterotopic formation of calcium in soft tissue. There have been few reports that describe dystrophic calcification causing brachial plexopathies. We describe a unique case of dystrophic calcification that caused entrapment of the posterior cord of the brachial plexus, something not previously described in the literature. CLINICAL PRESENTATION: We report the case of a 43-year-old woman with a medical history of congenital lymphangiomas of the left chest wall and axilla, for which she had undergone multiple surgeries and radioactive seed implantation. She presented 41 years later with progressive left arm paresthesias, pain, and weakness. Neurological findings were confined to the distribution of the posterior cord of the plexus. Radiographic evaluation demonstrated a 3 x 3 x 4-cm calcified mass in the axilla and proximal arm. INTERVENTION: A careful neurolysis and mass resection was performed. At exploration, the posterior cord, proximal radial nerve, and brachial artery were found to be densely adherent to a calcified mass. Reconstruction of the brachial artery and free tissue transfer were required for healing of the severely scarred wound. Pathological examination revealed dense, calcified connective tissue consistent with dystrophic calcification. She made an excellent recovery. CONCLUSION: We describe a rare case of dystrophic calcification of the proximal arm causing symptomatic brachial plexopathy, with onset many years after surgery and radiation. Diagnostic evaluation and surgical management are discussed.

Adult↗

PubMed1999

Reduced size of liquefaction necrosis of mitral annular calcification in chronic renal failure by using low calcium concentration hemodialysis.

A report is presented of a liquefaction necrosis of mitral annular calcification in a patient with chronic renal failure and secondary hyperparathyroidism who had been managed by hemodialysis for 11 years. The mass was echogenic with an echo-lucent area inside, high density on computed tomography and low intensity on magnetic resonance imaging. The uptake of gallium-67 (67Ga)-citrate and the bone agent technetium-99m-methylene diphosphate (99mTc-MDP) was seen in the mass. These findings were compatible with liquefaction necrosis of the mitral annular calcification. After treatment with low calcium concentration hemodialysis, the size of the mass reduced with disappearance of the echo-lucent area on the echocardiography and there was no uptake of 67Ga-citrate or 99mTc-MDP. Liquefaction necrosis might be the early and reversible form of mitral annular calcification. When a tumorlike echogenic mass at the base of mitral leaflets is seen in patients with predisposing factors for mitral annular calcification, consider the possibility of this specific form of mitral annular calcification in order to avoid any unnecessary surgical intervention.

Calcinosis↗

PubMed1982

Calcification in pulmonary metastases.

A large variety of neoplasms can produce calcified lung metastases. Three unusual examples are presented and the relevant literature is reviewed. Each case involves a neoplasm not previously reported to produce calcified lung metastases: malignant mesenchymoma, fibrosarcoma of the breast, and medullary carcinoma of the thyroid. The sarcomas are reported in the literature to develop calcified lung metastases are osteogenic sarcoma, chondrosarcoma, synovial sarcoma, and giant cell tumour. Among carcinomas, the papillary and mucinous adenocarcinomas are the histological types most likely to develop calcified lung metastases. The metastases of a number of other tumours have calcified after antineoplastic therapy. Calcification in metastases arises through a variety of mechanisms: bone formation in tumour osteoid, calcification and ossification of tumour cartilage, dystrophic calcification and ossification of tumour cartilage, dystrophic calcification and mucoid calcification. Since calcified lung metastases can strongly resemble granulomas or hamartomas, a reasonable suspicion of malignancy is necessary when evaluating calcified pulmonary nodules.

Adult↗

PubMed1996

Intracranial arterial calcification and ectasia in visual failure.

Calcification of the major intracranial arteries is frequently observed on computed tomography (CT), particularly in the carotid siphon, and has been implicated as a causative factor in low tension glaucoma. Ectasia of the carotid siphon has also been postulated as a possible cause of compressive optic neuropathy. 153 patients, in whom high resolution CT of the orbits and parasellar region had been performed for suspected anterior visual pathway pathology, were retrospectively reviewed. The presence and severity of calcification and ectasia of the major intracranial arteries was recorded. There was a high occurrence of carotid siphon calcification, increasing with age, and independent of sex or race. Calcification was very rare in anterior cerebral, middle cerebral and basilar arteries in all age groups. The amount and degree of ectasia also increased with advancing age, and was more frequently observed in carotid and basilar than anterior and middle cerebral arteries. There was no correlation between the degree of calcification or ectasia and ophthalmological or neurological deficit.

Adolescent↗

PubMed1999

A comparison of 14 and 12 gauge needles for core biopsy of suspicious mammographic calcification.

This study was carried out to compare the efficacy of 14 vs 12 G needles in stereotactic core biopsy of mammographic calcification. A consecutive series of 100 impalpable mammographic calcifications, without an associated mass and requiring stereotactic core biopsy were randomly allocated to either 14 G or 12 G needle sampling. All biopsies were performed using an upright stereotactic digital unit (Senovision GE) and a Bard automated biopsy gun. Core biopsy results were categorized as either normal, benign, atypical ductal hyperplasia, suspicious of ductal carcinoma in situ (DCIS), DCIS or invasive cancer. The radiographic calcification retrieval rates, complete and absolute sensitivity for malignancy of DCIS and DCIS with an invasive focus were obtained by comparison of core results with surgical histology. Radiographic calcification retrieval was achieved in 86% when using 14 G and 12 G needles. The absolute sensitivity and complete sensitivity for diagnosing DCIS were the same with 12 G and 14 G needles (72% versus 71% and 93% versus 94%, respectively). The use of 12 G needles does not appear to confer benefit over the use of 14 G needles in the diagnosis of mammographic calcification.

Biopsy, Needle↗

PubMed2002

Scrotal calcification: ultrasound appearances, distribution and aetiology.

This pictorial review illustrates the ultrasound appearances of scrotal calcification, distinguishing between intratesticular and extratesticular calcification. Intratesticular calcification may be due to phleboliths, spermatic granulomas or vascular calcification, or it may occur in association with tumours. Extratesticular calcification is more frequently encountered and is usually related to previous inflammatory disease of the epididymis. Testicular microlithiasis, a rare condition characterized by multiple scattered echogenic foci within the testis, is produced by the formation of microliths from degenerating cells in the seminiferous tubules. Testicular microlithiasis has been demonstrated as an incidental finding as well as in association with both benign and malignant tumours of the testis.

Calcinosis↗

PubMed2005

The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease.

OBJECTIVES: To determine the prevalence of carotid calcification on dental panoramic radiographs in end-stage renal disease (ESRD) patients on haemodialysis and renal transplant recipients. METHODS: Panoramic radiographs of 69 adult patients with renal disease (34 with haemodialysis and 35 with renal transplantations) (age range 17-74 years; mean age 39.45 years) and 50 controls (age-match, free of systemic disease) were examined on panoramic radiographs for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. Patients with such calcifications were referred to ultrasound examination. Using Chi-squared tests, calcification prevalence rates were statistically compared. RESULTS: The statistical difference between renal disease patients and control group was significant (chi2 = 17.91, P < 0.001). On comparison of haemodialysis patients and renal transplant recipients with controls, statistical difference (P=0.007) was found to be significant. CONCLUSION: Carotid artery calcification was higher in haemodialysis patients and renal transplant recipients. These patients with such calcifications should be referred for further evaluation and treatment of carotid arteries, coronary arteries and vascular risk factors.

Adolescent↗

PubMed1982

Intervertebral disc calcification syndromes in children.

One hundred and twenty-seven cases of intervertebral disc calcification in children, including 11 previously unreported cases, have been analysed. A distinction is made between symptomatic and asymptomatic patients, whose age, sex and spinal distributions of the calcifications have been shown to differ. Radiologically detectable protrusions and later resorption of the calcifications are common events in symptomatic children, but are unrecorded in asymptomatic children. The spinal distribution of paediatric calcifications is quite different to that of adult and canine calcifications of the nucleus pulposus.

Adolescent↗

PubMed2003

Renal calcification in mice homozygous for the disrupted type IIa Na/Pi cotransporter gene Npt2.

Mice homozygous for the disrupted renal type IIa sodium/phosphate (Na/Pi) cotransporter gene (Npt2-/-) exhibit renal Pi wasting, hypophosphatemia, and an adaptive increase in the serum concentration of 1,25-dihydroxyvitamin D with associated hypercalcemia and hypercalciuria. Because hypercalciuria is a risk factor for nephrocalcinosis, we determined whether Npt2-/- mice form renal stones. Analysis of renal sections by von Kossa staining and intact kidneys by microcomputed tomography revealed renal calcification in adult Npt2-/- mice but not in Npt2+/+ littermates. Energy-dispersive spectroscopy and selected-area electron diffraction indicated that the calcifications are comprised of calcium and Pi with an apatitic mineral phase. To determine the age of onset of nephrocalcinosis, we examined renal sections of newborn and weanling mice. At both ages, mutant but not wild-type mice display renal calcification, which is associated with renal Pi wasting and hypercalciuria. Immunohistochemistry revealed that osteopontin co-localizes with the calcifications. Furthermore, renal osteopontin messenger RNA abundance is significantly elevated in Npt2-/- mice compared with Npt2+/+ mice. The onset of renal stones correlated developmentally with the absence of Npt2 expression and the expression of the genes responsible for the renal production (1alpha-hydroxylase) and catabolism (24-hydroxylase) of 1,25-dihydroxyvitamin D. In summary, we show that Npt2 gene ablation is associated with renal calcification and suggest that mutations in the NPT2 gene may contribute to nephrocalcinosis in a subset of patients with familial hypercalciuria.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗

PubMed1994

Metastatic pulmonary calcification mimicking air-space disease. Technetium-99m-MDP SPECT imaging.

Metastatic pulmonary calcification (MPC), a complication of chronic renal failure, is uncommonly diagnosed antemortem, yet may be a significant etiology of pulmonary dysfunction in patients with renal failure. The degree of respiratory distress often does not correlate with the degree of macroscopic calcification. Patients with extensive calcification may be asymptomatic, while others with subtle calcification or normal chest radiographs may have severe respiratory compromise. Additionally, the findings on chest radiographs may be confused with air-space disease, including pulmonary edema and pneumonia. Radionuclide imaging may detect MPC in the setting of normal chest radiographs, and confirm the diagnosis when there are radiographic findings of air-space disease without macroscopic calcification. We present a patient with bilateral upper lobe disease suspected to represent edema or pneumonia, proven to represent MPC on 99mTc MDP scintigraphy with single photon emission computed tomography (SPECT), CT, and later at transbronchial biopsy.

Bone and Bones↗

PubMed2002

Aortic calcification on plain chest radiography increases risk for coronary artery disease.

STUDY OBJECTIVES: To determine whether an association exists between aortic calcification viewed on plain chest radiography and coronary artery disease. METHODS: Retrospective review of all chest radiographs obtained from consecutive patients undergoing coronary angiography at a primary cardiac center during 1999. Plain chest radiographs were reviewed by blinded radiologists, and interobserver consistency was measured. The presence or absence of aortic arch calcification was abstracted and compared with the results of coronary angiography. RESULTS: Of 654 cases, 329 of 360 patients with aortic arch calcification vs. 241 of 294 patients without aortic arch calcification had coronary artery disease demonstrated on angiography. The 9% absolute difference in proportions was significant (p = 0.0003). The relative risk (measured by risk ratio) was 1.11 (95% confidence interval, 1.05 to 1.19). CONCLUSION: Several objective signs (e.g., hypertension, hyperlipidemia, and ECG changes) have been associated previously with the presence of coronary artery disease. This study further suggests an association between coronary disease and aortic arch calcification on plain chest radiography. These results may assist primary-care providers performing routine health assessments as well as emergency practitioners evaluating patients with potential angina.

Adult↗

PubMed2004

Prevention of calcification in bioprosthetic heart valves: challenges and perspectives.

Surgical replacement with artificial devices has revolutionised the care of patients with severe valvular diseases. Mechanical valves are very durable, but require long-term anticoagulation. Bioprosthetic heart valves (BHVs), devices manufactured from glutaraldehyde-fixed animal tissues, do not need long-term anticoagulation, but their long-term durability is limited to 15 - 20 years, mainly because of mechanical failure and tissue calcification. Although mechanisms of BHV calcification are not fully understood, major determinants are glutaraldehyde fixation, presence of devitalised cells and alteration of specific extracellular matrix components. Treatments targeted at the prevention of calcification include those that target neutralisation of the effects of glutaraldehyde, removal of cells, and modifications of matrix components. Several existing calcification-prevention treatments are in clinical use at present, and there are excellent mid-term clinical follow-up reports available. The purpose of this review is to appraise basic knowledge acquired in the field of prevention of BHV calcification, and to provide directions for future research and development.

Calcinosis↗

PubMed2005

Multifunctional roles for serum protein fetuin-a in inhibition of human vascular smooth muscle cell calcification.

Vascular calcification predicts an increased risk for cardiovascular events/mortality in atherosclerosis, diabetes, and ESRD. Serum concentrations of alpha(2)-Heremens-Schmid glycoprotein, commonly referred to as fetuin-A, are reduced in ESRD, a condition associated with an elevated circulating calcium x phosphate product. Mice that lack fetuin-A exhibit extensive soft tissue calcification, which is accelerated on a mineral-rich diet, suggesting that fetuin-A acts to inhibit calcification systemically. Western blot and immunohistochemistry demonstrated that serum-derived fetuin-A co-localized with calcified human vascular smooth muscle cells (VSMC) in vitro and in calcified arteries in vivo. Fetuin-A inhibited in vitro VSMC calcification, induced by elevated concentrations of extracellular mineral ions, in a concentration-dependent manner. This was achieved in part through inhibition of apoptosis and caspase cleavage. Confocal microscopy and electron microscopy-immunogold demonstrated that fetuin-A was internalized by VSMC and concentrated in intracellular vesicles. Subsequently, fetuin-A was secreted via vesicle release from apoptotic and viable VSMC. Vesicles have previously been identified as the nidus for mineral nucleation. The presence of fetuin-A in vesicles abrogated their ability to nucleate basic calcium phosphate. In addition, fetuin-A enhanced phagocytosis of vesicles by VSMC. These observations provide evidence that the uptake of the serum protein fetuin-A by VSMC is a key event in the inhibition of vesicle-mediated VSMC calcification. Strategies aimed at maintaining normal circulating levels of fetuin-A may prove beneficial in patients with ESRD.

Blood Proteins↗

PubMed1994

Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization.

Acute calcific retropharyngeal tendinitis is an underrecognized cause of pain and stiffness in the neck associated with odynophagia and retropharyngeal soft-tissue swelling. We report on five patients in whom an initial misdiagnosis of this entity as a retropharyngeal or nasopharyngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as admission to the hospital and parenteral administration of antibiotics. An open biopsy was performed in one patient because of a suspected neoplasm. Evaluation of the tissue specimen with routine and polarized light microscopy, scanning electron microscopy, and energy-dispersive spectrometry demonstrated a foreign-body inflammatory response to deposited crystals of hydroxyapatite. In all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who was familiar with acute calcific retropharyngeal tendinitis. The computed tomographic findings of acute calcific retropharyngeal tendinitis are distinctive and consist of prevertebral calcification localized to the insertion of an edematous tendon of the longus colli muscle. Symptomatic relief was provided with anti-inflammatory and analgesic medications. The symptoms resolved, without sequelae, within one to two weeks for all of the patients. We hope that an increased awareness of hydroxyapatite deposition in the tendon of the longus colli muscle will result in improved early diagnosis of acute calcific retropharyngeal tendinitis.

Abscess↗

PubMed1997

Severity of coronary artery calcification detected by electron beam computed tomography is related to the risk of restenosis after percutaneous transluminal coronary angioplasty.

To assess the relationship between coronary artery calcification and the late success rate of percutaneous transluminal coronary angioplasty (PTCA), we performed electron beam computed tomography (EBCT) in 22 patients with ischemic heart disease who underwent PTCA. The calcification score in each coronary artery vessel was estimated and compared with the occurrence of restenosis at 3 months after PTCA. Angioplasty had been performed in 28 sites in 22 patients, and 12 sites exhibited restenosis. The mean calcium score in the unsuccessful PTCA vessels was significantly higher than in successful sites (228 vs 92). The overall late success rate of PTCA with moderate to severe calcification was extremely low at 29%. Coronary segments with diffuse and extensive calcification were not optimal target lesions for PTCA. Prediction of the late success rate after PTCA may be possible by prior evaluation of coronary artery calcification utilizing EBCT.

Aged↗

PubMed2006

Molecular determinants of vascular calcification: a bench to bedside view.

Vascular calcification (VC) is an orchestrated event, evoking the programmed process of the osteogenesis and triggered by inflammatory cytokines active at vascular level. VC is a dynamic process in which the vessel wall intima, media and also cardiac valves may be involved. Intimal calcification is an endochondral ossification process in which type II collagen is mineralized by calcium deposition. In contrast, an intra-membranous ossification process leads to medial calcification, while a dystrophic calcification process is responsible for valvular calcification. Mechanisms involved in VC may be summarized as: 1. Activation of osteogenesis in the vessel wall, 2. Loss of inhibitory factors, 3. Enhanced bone turnover, and 4. Abnormalities in mineral metabolism. The signaling axis constituted by osteoprotegerin (OPG), receptor activator nuclear factor kB (RANK) and its ligand (RANKL), along with the monocyte colony stimulating factor (M-CSF) and the transcription factor core Binding protein (Cbfa-1), play a pivotal role in the control of VC. In contrast, fetuin-A, matrix G1a protein (MGP) and osteopontin (OPN) control the inhibition of VC. In addition, abnormal mineral metabolism with enhanced phosphates availability favors calcium deposition. The inflammatory cytokines interleukin (IL-1) and tumor necrosis factor (TNF)-alpha enhance OPG and RANKL function in the vessel wall leading to VC. VC is a controlled process, depending on the balance between osteoblastic and osteoclastic influences and further modulated by the influence of risk factors like diabetes, smoking, age, hypertension and dyslipidemia. Recent advances in diagnostic tools such as with multi-detector computed tomography (MDCT) and electron beam computed tomography (EBCT), may help diagnosis and delineation of VC in the clinical setting and aid in understanding its prognostic value.

Animals↗