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Jan 6 2009, 4:29 PM EST M.J.Fuller 73 words added, 7 words deleted
Jan 5 2009, 8:16 PM EST M.J.Fuller

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Introduction
Soft Tissue Calcification identification can be a useful skill for radiographers who work in the Emergency Department. Timely identification of soft tissue calcification can expedite the patient's imaging and save the patient from unnecessary additional imaging (particularly comparison views). From the Radiologist's point of view soft tissues calcifications are usually not problematicproblematic, but occasionally pop up as incidental findings and, as one author noted, "it behooves the radiologist to say something intelligent about them" http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/soft-tissue-calcifications

Types of soft tissue calcification

  1. Dystrophic Calcification

  2. Metastatic Calcification

  3. Calcinosis
  4. Chondrocalcinosis
  5. Synovial Chondromatosis.
Appearances
Type
IncidenceExamplesAppearance
Dystrophic Calcification95 - 98 %

small to large amorphous Ca++ in the damaged tissue -- may progress to ossification (formation of cortex and medullary space are then seen)
Metastatic Calcification
1 - 2%
Entities such as renal failure, hyperparathyroidism, sarcoidosis, milk-alkali syndrome, etc. can lead to metastatic calcifications.finely speckled calcification throughout soft tissues
Calcinosis
1 - 2%Calcification of cutaneous, subcutaneous or deep connective tissue.
  • Not associated with metabolic disturbance.
  • May be associated with with collagen-vascular disease.
  • 3 Types:
1. Calcinosis circumscripta
2. Calcinosis universalis
3. Tumoral calcinosis
Chondrocalcinosis
(CPPD)(Calcium pyrophosphate dihydrate deposition disease- CPPD)

1 - 2 %

CalciumNon-specific calcification of cartilage
Gout -- calcium urate crystals
Pseudogout - calcium pyrophosphate
Ochronosis dihydrate– depositionhomogentisic diseaseacid oxidase
Hyperparathyroidism
Diabetes
Degenerative disea

  • (CPPD) is usually associated with chondrocalcinosis.
    This typically appears as a fine white line overlying the hyaline articular cartilage.
  • CPPD is also associated with calcifications in the soft tissues of the spine.
Synovial Chondromatosis




Dystrophic Calcification
The Department of Radiology at the University of Washington provide a simple english description of dystrophic calcification as follows

"As you can see, almost every calcification that one sees in the soft tissues in actual radiographic practice is due to dystrophic calcification. What does this mean? Simply this: when tissue is damaged, the body responds to this injury in a nonspecific manner by invoking the generic inflammatory response reaction. This sometimes ends with calcification of the damaged tissue. This calcification is probably usually only microscopic, but is occasionally enough to be seen radiographically."






http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials/online-musculoskeletal-radiology-book/soft-tissue-calcifications

  • Calcification in damaged or degenerating tissue by small to large amorphous calcium deposit.
  • Not associated with metabolic disorder.
  • Almost every calcification that one sees in the soft tissues in actual radiographic practice is due to dystrophic calcification.
  • They have a prevalence of 95-98% out of all soft tissue calcification.
http://www.squidoo.com/bonexray


Differential diagnosis of dystrophic calcification

Mnemonic = VINDICATE (VINDAT)

V = Venous - Phlebolith

I = Infection - Cysticercosis

N = Neoplasm - Osteosarcoma

D = Drugs - Vitamin D overdose

A = Autoimmune - Dermatomyositis

T = Trauma - Hematoma, Heterotopic ossification

dystrophic calcificationDystrophic calcification associated with hip joint (arrowed)