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Weekly Chest CasesArchive of Old Cases

Case No : 829 Date 2013-09-16

  • Courtesy of Hong Ji Hoon, Im Jae Gwang / Kyungpook National University Hospital
  • Age/Sex 51 / F
  • Chief Complaintknown progressive systemic sclerosis with ILD, routine follow-up CT scan
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Tumoral calcinosis associated with systemic sclerosis
Radiologic Findings
Lung window setting of chest CT scan shows honeycombing change and pulmonary fibrosis in the both lungs.
Mediastinal window setting of the chest CT scan shows multilobulated soft tissue mass with calcification in the left scapulothoracic area and esophageal stenosis.
Brief Review
Classic tumoral calcification is lobular, densely calcified masses consisting of pleomorphic calcium phosphate (hydroxyapatite) crystals and confined to the soft tissue, generally at the extensor surface of the joint in the anatomical distribution of a bursa.
Common location is hip, elbow, shoulder, foot and wrist. Smack et al classified tumoral calcinosis into 3 categories: a) Primary normophosphatemic tumoral calcinosis, b) Primary hyperphosphatemic tumoral calcinosis, c) Secondary tumoral calcinosis
Secondary tumoral calcinosis is associated with renal failure, hemodialysis, collagen vascular disease (particularly scleroderma or dermatomyositis), sarcoidosis, pseudoxanthoma elasticum, massive osteolysis and other conditions. Pathogenesis is thought to chronic soft-tissue inflammation and dystrophic calcification, but not clearly known.
Tumoral calcinosis has a typical appearance on radiographs: Usually involving subcutaneous tissues and paraarticular distribution, macroscopic masses of amorphous calcified material and multilobulated mass of several centimeters with amorphous calcific deposit. A cystic component may be present as fluid-sedimentation level or calcium layering known as "sedimetation" sign.
References
1. Kathryn M. et al.,Tumoral Calcinosis: Pearls, Polemics, and Alternative Possibilities, Radiographics 2006; 26: 871-885
2. Smack et al., Proposal for a pathogenesis-based classification of tumoral calcinosis, Int J Dermatol 1996;174:215-222
3. Elias P. et al., Extensive Tumoral Calcinosis in a Patient With Systemic Sclerosis, Am J Orthop. 2010;39(10):E108-110
Keywords
Lung, Metabolic and storage lung disesae, Interstitial lung disease,

No. of Applicants : 74

▶ Correct Answer : 45/74,  60.8%
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - ACE DIAGNOSTICS , India DAMANDEEP CHAWLA
  • - Scans world , India Philson Mukkada
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - sahyadri speciality hospital , India kothareddy dileepreddy
  • - ghtm , India yazhini v
  • - GHICL , France manuel toledano
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Columbia Asia , India John Joseph
  • - Kyoto University , Japan Akihiko Sakata
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Niigata University , Japan Atsushi Uehara
  • - Chonbuk University Hospital , Korea (South) Sungkwan Kim
  • - McGill university , Canada Badriya Al-Qassabi
  • - Breach Candy Hospital , India Sheetal Pote
  • - , Korea (South) Chan Park
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - university of montreal , Canada Andrei Gorgos I
  • - Asan medical center , Korea (South) yoonyoung choi
  • - AMC , Korea (South) park jong chun
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - ASAN MEDICAL CENTER , Korea (South) CHONG HYUN SUH
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Myongji hostipal , Korea (South) Yongsuk Jang
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - University of Rochester , United States John Strang
  • - otsu municipal hospital , Japan kenjirou iwaya
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - b&b hospital , Nepal umesh sharma
  • - DCA, , India Rajesh Gothi
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - GHOL, Hopital de Nyon , Switzerland Benoit Rizk
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - IRSA La Rochelle , France Denis Chabassiere
  • - district tuberculosis centre,poonamallee , India gayathri ganesh
  • - Vikram hospital , India Pravin Mahadevappa
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 8/74,  10.8%
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
  • - TCM HOSPITAL OF ZIGONG , China Cao Cunyou
  • - CAC Rennes , France nicolas gautier
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - All India Institute of medical sciences , India Justin Moses
  • - NASA SCANS ROHINI NEW DELHI , India RAKESH BHATIA
▶ Semi-Correct Answer : 1/74,  1.4%
  • - University of British Columbia , Canada Amr Ajlan
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