Secondary Tumoral Calcinosis with Intraosseous Penetration

Abstract

We report a case of a 55-year-old woman with chronic renal failure and secondary tumoral calcinosis with rare intraosseous penetration of the humerus. Typical lobulated calcifications with associated layering "milk of calcium" were present about the right shoulder and elbow on conventional radiographs, computed tomography images and magnetic resonance images. Rare appearance of cortical destruction and intraosseous extension of tumoral calcinosis into the medullary space was observed in the proximal humerus on CT and MR images. Since there is concern for pathologic fracture, radiologists should be aware of this rare complication of chronic renal disease.

Keywords: CT, computed tomography; MRI, magnetic resonance imaging.

Figure 1

55-year-old woman with secondary tumoral calcinosis. Erect AP radiograph of right humerus shows well-demarcated lobulated masses containing layering milk of calcium about right elbow, shoulder, and chest wall.

Figure 2

55-year-old woman with secondary tumoral calcinosis. (A-B) Axial CT images of the right upper extremity show lobulated soft tissue masses with multiple fluid-calcium levels. Note cortical destruction of the proximal humerus by tumoral calcinosis with extension into the intramedullary cavity. (C) Coronal CT image of the right upper extremity shows lobulated soft tissue masses with fluid-calcium levels. Note cortical destruction of the proximal humerus by tumoral calcinosis with extension into the intramedullary cavity.

Figure 2

55-year-old woman with secondary tumoral calcinosis. (A-B) Axial CT images of the right upper extremity show lobulated soft tissue masses with multiple fluid-calcium levels. Note cortical destruction of the proximal humerus by tumoral calcinosis with extension into the intramedullary cavity. (C) Coronal CT image of the right upper extremity shows lobulated soft tissue masses with fluid-calcium levels. Note cortical destruction of the proximal humerus by tumoral calcinosis with extension into the intramedullary cavity.

Figure 3

55-year-old woman with secondary tumoral calcinosis. Axial CT image of the arm shows multiloculated cystic lesions of tumoral calcinosis with fluid-calcium levels.

Figure 4A

55-year-old woman with secondary tumoral calcinosis. (A) Axial CT image of the right upper extremity showing soft tissue calcification (C) with bony erosion (arrow) of the right second rib (R).

Figure 4B

55-year-old woman with secondary tumoral calcinosis. (B) Coronal CT image of the right upper extremity showing bony erosion (arrow) of the right second rib (R).

Figure 5

55-year-old woman with secondary tumoral calcinosis. Sagittal STIR MRI shows intra-osseous penetration into the intramedullary cavity of the proximal humerus and fluid-calcium levels.