Thread by @RyanChristieMD

Wetread Case 34

Hx: palpable mass (No X-rays. 🤷‍♂️)

Diagnosis? Any relevant medical history you can think of?

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad

Answer: Calcinosis of Chronic Renal Failure (ie Secondary Tumoral Calcinosis)

Yes, Dialysis/renal failure is the key!

#WetreadCow #FOAMrad #FOAMed #radres #errad #mskrad #orthorad

Different patient:

True Tumoral Calcinosis (TC) is ususally reserved for the hereditary dysfunction of phosphate regulation yielding large, painless, periarticular Ca+.

Here we have the exact same finding except secondary to chronic renal failure, thus “secondary” or “uremic” tumoral calcinosis.

Cause is generally believed related to associated hyperparathyroidism of CRF (👀 for other findings)

Interestingly CRF is actually the most frequent cause of a periarticular calcified mass. And there are no radiographic or histologic differences between primary or secondary TC.

Rad Findings of TC:

- Amorphous, multilobulated Ca++ located about a joint.
+/- cystic w/ layering milk of calcium (sedimentation sign).
- Can be homogeneous (⬇️ activity and ⬇️ growth)
- Not connected to underlying bone
- No osseous erosion or destruction by the mass

Location: Hip > shoulder > elbow > foot > wrist

Clinical: palpable mass, classically painless

Treatment: Primarily dialysis and phosphate depletion (diet, phosphate binders)

Stay Safe!👍😀