Calcification

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Calcification

  1. 1. Calcification Intracranial globe Pleural Pulmonary Breast Soft tissue Periarticular soft tissue Cartilage Vascular Abdominal Pancreatic Renal Adrenal Pelvic Dr/ Hytham Nafady
  2. 2. Intra-cranial calcification
  3. 3. Intra- cranial calcification Physiologic Congenital Phakomatoses TS SW VHL Infection Congenital TORCH Acquired TB NCCGliosis Metabolic Hyper-parathyroidism Hypo-parathyroidism Fahr Tumor Intraaxial Oligodendroglioma Extra-axial Meningioma Craniophyrngioma Intraventricular Ependymoma Neurocytoma Vascular Atherosclerosis AVM Aneurysm Post-irradiation Mineralizing MA
  4. 4. •Calcified subependymal nodules at the caudothalamic groove. •Calcified cortical tubers. Tuberous sclerosis •Gyriform calcification. •Ipsilateral hemiatrophy. Sturge Weber •Parenchymal calcification.Toxoplasmosis •Periventricular calcificationCytomegalovirus •Bilateral golbus pallidus calcification.Rubella •Calcified granulomas.TB •Calcification of basal ganglia, thalami & subcortical white matter.Hyper / hypo parthyroidism / Fahr •Calcified intra-axial frontal mass lesionOligodendroglioma •Calcified extra-axial dural based mass lesionMeningioma •Calcified supra-sellar solid and cystic mass lesionCraniopharyngioma •Serpentine & punctate intra-axial calcifications with negative mass effect.Calcifid AVM •Calcified extr-axial rounded lesion.Calcified aneurysm •Post-irradiation. •Calcification at the corticomedullary junction Mineralizing microangiopathy
  5. 5. Physiologic intracranial calcification Physiologic intracranial calcification Globus pallidus Pineal gland Falx Choroid plexus Tentorium Habenula Dentate nucleus
  6. 6. Bilateral globus pallidus calcification • Punctate. • > 30 ys.
  7. 7. Pineal gland & choroid plexus
  8. 8. Falx calcification
  9. 9. Dentate nucleus
  10. 10. Hyperparathyroidism
  11. 11. Cysticercosis
  12. 12. Central neurocytoma
  13. 13. Calcified meningioma
  14. 14. Cranipharyngioma
  15. 15. Ependymoma
  16. 16. Subependymoma
  17. 17. Oligodendroglioma
  18. 18. Calcified cavernous malformation
  19. 19. Calcified subdural hematoma
  20. 20. Mineralizing microangiopathy • Post-radiation • Calcification at cortico-medullary junction.
  21. 21. Eye globe calcification
  22. 22. Globe calcification Retinal Drusen Retinoblastoma Retrolental fibroplasia (retinopathy of prematurity) Coat’s disease (retinal telangiectasia) TS Retino-choroidal Chorio-retinitis Choroidal Chroidal osteoma Sclero-choroidal Metastatic calcification Phthisis bulbi It is not possible to separate these layers on CT
  23. 23. • Calcified optic disc. • 1% of the population Drusen • Calcified intra-ocular mass. • Bilateral in 40 % of cases • Endophytic, exophytic or combined. Retinoblastoma • Retinopathy of prematurity. • Oxygen therapy. Retrolental firoplasia • Retinal telangiectasia.Coat’s disease • ToxoplasmosisChorioretinitis • Curvilinear • TS patients. Choroidal osteoma • Hyperparathyroidism. • Renal tubular acidosis. Metastatic calcification • Collapsed calcified eye globe. • End result of trauma or infection. Phthisis bulbi
  24. 24. Bilateral macular calcification
  25. 25. Optic disc drusen
  26. 26. Choroidal osteoma
  27. 27. Calcified bilateral retinoblastoma
  28. 28. Phthisis bulbi
  29. 29. Pleural calcification
  30. 30. Pleural calcification Unilateral Chronic empyema Old hemothorax Bilateral Asbestosis Silicosis
  31. 31. Pleural calcification • Usually unilateral. • Associated with pleural thickening. Chronic empyema • Usually unilateral. • Associated with pleural thickening.Old hemothorax • Usually multiple & bilateral • Spare lung bases & apices. • Holly leaf appearance (denser at the periphery). Asbestosis • Limited. • Punctate.Silicosis
  32. 32. TB empyema
  33. 33. Asbestosis
  34. 34. Silicosis
  35. 35. Pulmonary calcification
  36. 36. Pulmonary calcification Calcified pulmonary nodule Healed infection Occupational lung disease Calcified metastases Pulmonary hemosiderosis Pulmonary alveolar microlithiasis Metastatic pulmonary calcification Chronic renal failure (most common cause)
  37. 37. Calcified pulmonary nodules •Calcified granuloma (T.B) •Varicella pneumoniaHealed infection •Silicosis •Coal worker’s pneumoconiosis. Occupational lung disease •Osteosarcoma. •Chondrosarcoma. •Mucinous carcinomas. Calcified metastases •Primary •Secondary (mitral stenosis). Pulmonary hemosiderosis •Diffuse sand like calcifications. •Calcified interlobular septa. •Subpleural cysts •Black pleura sign. Pulmonary alveolar microlithiasis
  38. 38. Calcified pulmonary nodule Benign Diffuse Central Popcorn Laminated Malignant Eccentric Punctate
  39. 39. Calcified pulmonary nodule
  40. 40. Eccenteric calcification
  41. 41. Healed varicella pneumonia
  42. 42. Pulmonary alveolar microlithiasis • Sand like calcification through the whole lung.
  43. 43. Black pleura sign(alveolar microlithiasis)
  44. 44. Metastatic pulmonary calcification (chronic renal failure)
  45. 45. Breast calcification
  46. 46. Classification of breast calcification According to location Ductal Lobular Stromal Dermal Vascular Suture Artifactual from outside the breast According to morphology Benign Intermediate concern Malignant According to distribution Diffuse Regional Clustered Segmental Linear According to size Micro < 5m Macro > 5 mm
  47. 47. • Scattered or multiple similar clusters of calcification through the whole breastDiffuse • Scattered calcification in large volume > 2 cm. • Not in the expected ductal distributio n.Regional • calcium deposits in ducts and branches of a segment or lobe.Segmental • >/ = 5 calcifications in small volume of tissue < 1cm.Clustered • Calcifications arrayed in a line.Linear
  48. 48. Skin calcification • Rounded or polygonal, with radiolucent centre. • Bilateral and symmetrical. • Tattoo sign.
  49. 49. Rounded with radiolucent centre
  50. 50. Bilateral & symmetrical skin calcification
  51. 51. Bilateral symmetrical skin calcification
  52. 52. Tattoo sign
  53. 53. Tattoo sign
  54. 54. Idiopathic granulomatous mastitis • Coarse dystrophic calcification
  55. 55. Rod like calcification (ductectasia)
  56. 56. Rod like calcification (duct-ectasia)
  57. 57. Vascular calcifications
  58. 58. Suture calcification • Coarse linear
  59. 59. DCIS
  60. 60. DCIS
  61. 61. DCIS
  62. 62. Mass with DCIS extending toward the nipple
  63. 63. Soft tissue calcification
  64. 64. Soft tissue calcification Dystrophic Metastatic Calcinosis
  65. 65. Soft tissue calcification • Calcification of damaged or degenerated tissue. • With no underlying metabolic disorder. Dystrophic calcification • Calcification of normal tissue. • With underling metabolic disorder. Metastatic calcification • Calcification of cutaneous, subcutaneous & deep connective tissue. • With underling collagen vascular disease. Calcinosis
  66. 66. Classification of soft tissue dystrophic calcification • Heterotopic ossificatioin (myositis ossificans). • Injection granulomas Traumatic • Cysticercosis (rice grain calcification)). • Dracunculiasis. Parasitic infestation • Primary bone forming neoplasms (osteosarcoma). • Tumor necrosis. Neoplasm • Venous insufficiency.Vascular • Vitamin D.Drugs
  67. 67. Injection granulomas Pathogenesis: • Subcutaneous instead of intramuscular injection  fat necrosis  dystrophic calcification. Location: • gluteal region.
  68. 68. Injection granulomas
  69. 69. Cysticercosis (rice grain calcification)
  70. 70. Chronic venous insufficiency • Post-menopausal females • Predilection for calves • Subcutaneous • Sheet-like
  71. 71. Calcified or ossified neoplasms • Soft tissue osteosarcoma. • Soft tissue chondrosarcoma. • Synovial sarcoma.
  72. 72. Parosteal osteosarcoma
  73. 73. Calcinosis circumscripta • Cutaneous or subcutaneous. • Sharply marginated & punctate. • Around fingers. • Associated with sclerodactyly. • Causes: • CREST • Scleroderma.
  74. 74. Calcinosis universalis • Diffuse, sheet like calcification along the muscles, subcutaneous tissues, and fascial planes. • Typically involve the lower limbs. • Causes: (CT disorders): • Dermatomyositis. • SLE.
  75. 75. Calcinosis universalis
  76. 76. Chondrocalcinosis
  77. 77. Chondrocalcinosis Pathogenesis: • Gout (urate crystals). • Pseduogout (acute arthropathy with CPP crystals) • CPPD (osteoarthritis with CPP crystals). • Degenerative disease. DD Metastatic calcification: • 2ry hyperparathyroidism. • Diabetes.
  78. 78. Chondrocalcinosis Location: • Knees. • Hips. • Symphysis pubis. • Shoulder. • TFC.
  79. 79. Peri-articular soft tissue calcification
  80. 80. Periarticular soft tissue calcification Inflammatory Gout Scleroderma Dermato- myositis Degenerative Clacific tendinitis Calcific bursitis Metabolic Hyper- phosphatemia Renal failure Tumoral calcinosis Hyper- calcemia Hyper- vitaminosis D Milk alkali syndrome Sarcoidosis Metaplasia Synovial chondromatosis Neoplastic Synovial sarcoma
  81. 81. Gout tophi
  82. 82. Calcific trochanteric bursitis
  83. 83. Calcific biceps tendinitis
  84. 84. Tumoral calcinosis • Tumoral calcinosis is a hereditary disease of phosphate metabolic dysfunction. • Lobulated, well-demarcated calcification distributed most commonly around the extensor surface of large joints. • Tumoral calcinosis is misnomer (not tumor not calcinosis).
  85. 85. Tumeral calcinosis
  86. 86. 2ry, uremic or non familial tumoral calcinosis Renal dialysis
  87. 87. Synovial chondromatosis Pathology: • Metaplasia of synovial connective tissue. Location: • Any joint can be affected. • Knee  hip  shoulder  elbow. Distribution: • Monoarticular.
  88. 88. Synovial chondromatosis 1ry synovial chondromatosis 2ry synovial chondromatosis More numerous. Fewer in number. Uniform in size. Variable in size. Adjacent joint is normal. Associated with DJD
  89. 89. Synovial sarcoma
  90. 90. Vascular calcifications
  91. 91. Vascular calcification Arterial (walls) Monckberg’s arteriosclerosis Atherosclerosis Venous (Thrombi) Rounded small thrombi (Phlebliths) Long thrombi
  92. 92. Arterial calcification Monckberg’s arteriosclerosis Atherosclerosis Media Intima Continuous & railroad track like Discontinuous & plaque like Uremics & diabetics
  93. 93. Venous • Small thrombi (phleboliths) • Long thrombi. • Chronic venous insufficiency.
  94. 94. Phleboliths • Radiolucent centre.
  95. 95. Long thrombi
  96. 96. Pancreatic calcification
  97. 97. Pancreatic calcification • Chronic pancreatitis: • Pseudopancreatic cyst: curvilinear calcification. • Cystic fibrosis: finely granular. • Hyperparathyroidism: associated nephrocalcinosis & nephrolithiasis. • Kwashiorkor: • Tumors: cystadenomas & cystadenocarcinoma
  98. 98. Pancreatic calcification • Finely granular.Cystic fibrosis • Intraductal calculi (irregular & small).Chronic pancreatitis • Serous (calcified central scar) • Mucinous (peripheral marginal calcification). Cystadenoma or cystadenocarcinoma • Associated nephrocalcinosis & nephrolithiasisHyper-parathyroidism
  99. 99. Pancreatic calcification Inflammatory Chronic pancreatitis Congenital Cystic fibrosis Neoplastic Cystadenoma or cystadenocarcinoma Metabolic Hyperparathyroidism
  100. 100. Cystic fibrosis • Pancreatic atrophy & fatty replacement.
  101. 101. Chronic pancreatitis • Pancreatic calcification. • Pancreatic atrophy or enlargement. • Ductal dilatation. • Pseudocyst.
  102. 102. Serous cystadenoma
  103. 103. Mucinous cystadenoma
  104. 104. Abdominal calcifications
  105. 105. Abdominal Aortic Aneurysm
  106. 106. Bilateral adrenal calcification
  107. 107. Renal calcification Nephrocalcinosis Parenchymal calcification Dystrophic calcification Calcified cyst Calcified tumor Nephrolithiasis Pelvi-calyceal calcification
  108. 108. Nephrocalcinosis Nephrocalcinosis Medullary Cortical Common Less common
  109. 109. Medullary nephrocalcinosis Medulla Hyperparathyroidism Renal tubular acidosis Hypervitaminosis D Hypercalciuria Hyperoxaluria Pyramid Renal papillary necrosis
  110. 110. Medullary nephrocalcinosis • Most common cause of nephrocalcinosis in adults • Nephrocalcinosis related more to the duration than the intensity of hypercalcemia • Nephrocalcinosis occurs in 5% of cases of hyperparathyroidism. Primary hyperparathyroidism • Second most common cause of medullary nephrocalcinosis • Both familial and secondary forms have high incidence • Renal function is well maintained. Distal Renal Tubular Acidosis • In TTT of hyperparathyroidism.Hypervitaminosis D • ingestion of milk or alkali for ulcer dyspepsiaMilk-alkali syndrome Idiopathic hypercalciuria • Precipitation of calcium in dilated collecting ducts. • Large • Sharply defined. • Uneven distribution. Medullary sponge kidney • Calcified papillaeRenal papillary necrosis
  111. 111. Medullary nephrocalcinosis
  112. 112. Medullary nephrocalcinosis
  113. 113. Medullary nephrocalcinosis
  114. 114. Cortical nephrocalcinosis
  115. 115. Cortical nephrocalcinosis
  116. 116. Dystrophic renal calcification • Cysts. • Tumors. • Aneurysms.
  117. 117. Nephrolithiasis •Hyper-calcemia (hyperparathyroidism). •Hyper-uricemia (gout) •Hyper-oxaluria. High concentration of salts in urine: •Concentration of salts. Obstruction •Change of PH of urine •Alkaline urine (E coli infection) precipitation of phosphate salts •Acidic urine precipitation of oxalate salts. •Pus cells necrotic epithelium and blood clots provide nucleus for stone formation. Infection
  118. 118. Types of renal stones Renal stones radio-opaque (calcium containing) Calcium oxalate +/- calcium phosphate Most common 75% Struvite stone (triple phosphate) Stag horn stone Pure calcium phosphate Radio-lucent Uric acid Cystine
  119. 119. Bilateral adrenal calcification
  120. 120. Causes of adrenal calcification
  121. 121. Adrenal calcification Hemorrhage Most common cause Infection TB Histoplasmosis Tumors Neuroblastoma Pheochromocytoma Adrenal cortical adenoma Myelolipoma Calcified metastasis Addison disease Wolman disease Neonate
  122. 122. Calcified adrenal tumors • Most common solid abdominal mass in infancy • Almost always unilateral (90%) • Stippled or coarse calcification is common (up to 70%) Neuroblastoma • Rare tumor of adrenal medulla • May be bilateral (10%) • About 10% calcify Pheochromocytoma • Unilateral • Low attenuation (<10HU) on non-enhanced CT • Calcification is rare Adrenal cortical adenoma • Unilateral • Large, fat-containing adrenal mass • About 20% calcify. Myelolipoma • MelanomaCalcified metastasis
  123. 123. Calcified post-hemorrhagic pseudocyst (peripheral curvilinear calcification)
  124. 124. Calcified post-hemorrhagic pseudocyst
  125. 125. Calcified post-hemorrhagic pseudocyst
  126. 126. Bilateral adrenal myelolipoma
  127. 127. Calcified melanoma metastasis
  128. 128. Wolman disease
  129. 129. Wolman disease
  130. 130. Gall stones Right renal stone Rounded Irregular Radiolucent center Homogeneous Clustered together & conforms to the shape of the gall bladder Conforms to the shape of the renal pelvis or calyces
  131. 131. Lower abdominal / pelvic calcification • Vascular calcifications – Atherosclerosis – Aneurysms – Phleboliths • Urogenital – Uterine fibroid – Prostatic calcification – Seminal vesicle calcification – Bladder stones • Faecolith – Appendicolith – Colonic diverticulae – Meckel’s diverticulum. • Nodal calcification – Tuberculosis – Treated lymphoma – Carcinoid
  132. 132. Meckl’s diverticulitis
  133. 133. Calcified uterine fibroid

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