Calcification

Calcification

Intracranial

globe

Pleural

PulmonaryBreast

Soft tissuePeriarticular soft tissueCartilage

Vascular

Abdominal

Pancreatic

Renal

Adrenal

Pelvic

Dr/ Hytham Nafady

Intra-cranial calcification

Intra-cranial calcificationPhysiologic Congenital Phakomatoses TS

SWVHL

InfectionCongenital TORCHAcquired TB

NCCGliosis

Metabolic Hyper-parathyroidismHypo-parathyroidism

Fahr Tumor Intraaxial Oligodendroglioma

Extra-axialMeningioma CraniophyrngiomaIntraventricularEpendymoma

NeurocytomaVascular Atherosclerosis

AVMAneurysm

Post-irradiationMineralizing MA

•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 junctionMineralizing microangiopathy

Physiologic intracranial calcificationPhysiologic intracranial calcification

Globus pallidus

Pineal gland

Falx

Choroid plexus

Tentorium

Habenula

Dentate nucleus

Bilateral globus pallidus calcification

• Punctate.• > 30 ys.

Pineal gland & choroid plexus

Falx calcification

Dentate nucleus

Hyperparathyroidism

Cysticercosis

Central neurocytoma

Calcified meningioma

Cranipharyngioma

Ependymoma

Subependymoma

Oligodendroglioma

Calcified cavernous malformation

Calcified subdural hematoma

Mineralizing microangiopathy

• Post-radiation• Calcification at cortico-medullary junction.

Eye globe calcification

Globe calcificationRetinal Drusen

RetinoblastomaRetrolental fibroplasia

(retinopathy of prematurity)Coat’s disease

(retinal telangiectasia)TS

Retino-choroidal Chorio-retinitis

ChoroidalChroidal osteoma

Sclero-choroidalMetastatic calcification

Phthisis bulbi

It is not possible to separate these layers on CT

• Calcified optic disc.• 1% of the populationDrusen • 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

Bilateral macular calcification

Optic disc drusen

Choroidal osteoma

Calcified bilateral retinoblastoma

Phthisis bulbi

Pleural calcification


Unilateral

Chronic empyema

Old hemothorax

Bilateral

Asbestosis Silicosis


•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

TB empyema

Asbestosis

Silicosis

Pulmonary calcification

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)

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.



Benign

Diffuse

Central

Popcorn

Laminated

Malignant

Eccentric

Punctate


Eccenteric calcification

Healed varicella pneumonia


• Sand like calcification through the whole lung.

Black pleura sign(alveolar microlithiasis)

Metastatic pulmonary calcification (chronic renal failure)

Breast calcification

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

•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

Skin calcification

• Rounded or polygonal, with radiolucent centre.

• Bilateral and symmetrical.• Tattoo sign.

Rounded with radiolucent centre

Bilateral & symmetrical skin calcification

Bilateral symmetrical skin calcification

Tattoo sign

Tattoo sign

Idiopathic granulomatous mastitis

• Coarse dystrophic calcification

Rod like calcification (ductectasia)

Rod like calcification (duct-ectasia)

Vascular calcifications

Suture calcification

• Coarse linear

DCIS

DCIS

DCIS

Mass with DCIS extending toward the nipple

Soft tissue calcification


Dystrophic Metastatic Calcinosis


•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

Classification of soft tissue dystrophic calcification•Heterotopic ossificatioin (myositis ossificans).•Injection granulomasTraumatic •Cysticercosis (rice grain calcification)).•Dracunculiasis.Parasitic infestation

•Primary bone forming neoplasms (osteosarcoma).•Tumor necrosis.Neoplasm•Venous insufficiency.Vascular•Vitamin D.Drugs

Injection granulomas

Pathogenesis:• Subcutaneous instead of intramuscular

injection fat necrosis dystrophic calcification.

Location: • gluteal region.

Injection granulomas

Cysticercosis (rice grain calcification)

Chronic venous insufficiency

• Post-menopausal females• Predilection for calves• Subcutaneous• Sheet-like

Calcified or ossified neoplasms

• Soft tissue osteosarcoma.• Soft tissue chondrosarcoma.• Synovial sarcoma.

Parosteal osteosarcoma

Calcinosis circumscripta

• Cutaneous or subcutaneous.• Sharply marginated &

punctate. • Around fingers.• Associated with

sclerodactyly.• Causes:• CREST• Scleroderma.

Calcinosis universalis

• Diffuse, sheet like calcification along the muscles, subcutaneous tissues, and fascial planes.

• Typically involve the lower limbs. • Causes: (CT disorders):• Dermatomyositis.• SLE.

Calcinosis universalis

Chondrocalcinosis

Chondrocalcinosis

Pathogenesis:• Gout (urate crystals).• Pseduogout (acute arthropathy with CPP crystals)• CPPD (osteoarthritis with CPP crystals).• Degenerative disease.DD Metastatic calcification:• 2ry hyperparathyroidism.• Diabetes.

Chondrocalcinosis

Location:• Knees.• Hips.• Symphysis pubis.• Shoulder.• TFC.

Peri-articular soft tissue calcification

Periarticular soft tissue calcification

Inflammatory

Gout

Scleroderma

Dermato-myositis

Degenerative

Clacific tendinitis

Calcific bursitis

MetabolicHype

r-phosphatemiaRenal failure

Tumoral calcinosis

Hyper-

calcemiaHyper

-vitaminosis DMilk

alkali syndrome

Sarcoidosis

Metaplasia

Synovial chondrom

atosis

Neoplastic

Synovial sarcoma

Gout tophi

Calcific trochanteric bursitis

Calcific biceps tendinitis

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).

Tumeral calcinosis

2ry, uremic or non familial tumoral calcinosis

Renal dialysis

Synovial chondromatosis

Pathology:• Metaplasia of synovial

connective tissue.Location:• Any joint can be affected.• Knee hip shoulder

elbow.Distribution:• Monoarticular.

Synovial chondromatosis1ry synovial chondromatosis 2ry synovial chondromatosis

More numerous. Fewer in number.

Uniform in size. Variable in size.

Adjacent joint is normal. Associated with DJD

Synovial sarcoma

Vascular calcifications

Vascular calcification

Arterial(walls)

Monckberg’s arteriosclero

sisAtherosclero

sis

Venous(Thrombi)

Rounded small

thrombi(Phlebliths)

Long thrombi

Arterial calcificationMonckberg’s

arteriosclerosisAtherosclerosis

Media Intima

Continuous & railroad track like Discontinuous & plaque like

Uremics & diabetics

Venous

• Small thrombi (phleboliths)• Long thrombi.• Chronic venous insufficiency.

Phleboliths

• Radiolucent centre.

Long thrombi

Pancreatic calcification


• Chronic pancreatitis: • Pseudopancreatic cyst: curvilinear

calcification.• Cystic fibrosis: finely granular.• Hyperparathyroidism: associated

nephrocalcinosis & nephrolithiasis.• Kwashiorkor: • Tumors: cystadenomas & cystadenocarcinoma


•Finely granular.Cystic fibrosis

•Intraductal calculi (irregular & small).Chronic

pancreatitis

•Serous (calcified central scar)•Mucinous (peripheral marginal calcification).

Cystadenoma or cystadenocarcinoma

•Associated nephrocalcinosis & nephrolithiasis

Hyper-parathyroidism


InflammatoryChronic

pancreatitis

Congenital

Cystic fibrosis

Neoplastic

Cystadenoma or cystadenocarcinoma

Metabolic

Hyperparathyroidism

Cystic fibrosis

• Pancreatic atrophy & fatty replacement.

Chronic pancreatitis

• Pancreatic calcification.• Pancreatic atrophy or

enlargement.• Ductal dilatation.• Pseudocyst.

Serous cystadenoma

Mucinous cystadenoma

Abdominal calcifications

Abdominal Aortic

Aneurysm

Bilateral adrenal calcification

Renal calcification

Nephrocalcinosis

Parenchymal calcification

Dystrophic calcification

Calcified cystCalcified tumor

Nephrolithiasis

Pelvi-calyceal calcification

Nephrocalcinosis

Nephrocalcinosis

Medullary Cortical

Common Less common

Medullary nephrocalcinosis

Medulla

Hyperparathyroidism

Renal tubular acidosis

Hypervitaminosis D

Hypercalciuria

Hyperoxaluria

Pyramid

Renal papillary necrosis

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

Medullary sponge kidney

Renal papillary necrosis




Cortical nephrocalcinosis

Cortical nephrocalcinosis

Dystrophic renal calcification

• Cysts.• Tumors.• Aneurysms.

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

Types of renal stonesRenal stones

radio-opaque(calcium containing)

Calcium oxalate +/- calcium phosphate

Struvite stone (triple

phosphate)

Pure calcium phosphate

Radio-lucent

Uric acid

Cystine

Bilateral adrenal calcification

Causes of adrenal calcification

Adrenal calcification

Hemorrhage

Most common cause

Infection

TB

Histoplasmosis

Tumors

Neuroblastoma

Pheochromocytoma

Adrenal cortical adenoma

Myelolipoma

Calcified metastasis

Addison disease

Wolman disease

Neonate

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

Calcified post-hemorrhagic pseudocyst(peripheral curvilinear calcification)

Calcified post-hemorrhagic pseudocyst

Calcified post-hemorrhagic pseudocyst

Bilateral adrenal myelolipoma

Calcified melanoma metastasis

Wolman disease

Wolman disease

Gall stones Right renal stoneRounded IrregularRadiolucent center HomogeneousClustered together & conforms to the shape of the gall bladder

Conforms to the shape of the renal pelvis or calyces

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

Meckl’s diverticulitis

Calcified uterine fibroid

Health & Medicine

Calcification