Ossification & calcification

radiology
Ossification
calcification

1. Ossification & calcification

2. Types of calcification 1.Metastatic calcification ( abnormal calcium metabolism ) 2.Calcinosis( normal calcium metabolism, calcinosis circumscripta,calcinosis interstitialis universalis ) 3.dystrophic calcification (related to tissue damage )

3. Arterial calcification Venous calcification Neural calcification Calcification in lymph nodes Calcification in tendons Calcification associated with parasites Calcification associated with metabolic disorders.

4. Calcification associated with Hematomas Calcification associated soft tissue necrosis

5. Ossification Types. 1.Myocitis ossificans 2.Post traumatic myocitis ossificans .

6. Calcification in Arteries Irregularly athermanous plaques( Aorta,illiac,femoral arteries) Extent is not correlated to the severity of the disease. Curvilinear c alcification in a soft tissue mass adjacent to a vessel is typical for an aneurysm. Monkeberg,s medial atherosclerosis only media is involved no narrowing of the lumen of the artery appearance is a pipestem ring-like pattern.

7. Small vessels calcification DM,Hyperparthyroidism. Calcification of the vessels is not a feature of Buerger,s disease . Calcification in veins Phlebolith is a calcified thrombus in a vein ( 3-5 in length and has a central lucency) Normal finding in uterine and prostatic veins in the pelvis when a focal collection of phleboliths is seen elsewhere is a characteristic

8. cavernous haemangioma . Chronic venous stasis may cause subcutaneous calcification in a linear branching or plaque like pattern. Ulceration, phleboliths and well- organized periosteal reactions my also be present. Sometimes thrombus in a vein may calcify along its length.

9. Neural calcification. Rare but may occur in Leprosy & neurofibromatosis.

10. Calcification in tendons,patella,Achilles Due to chronic trauma or inflammation Rotator cuff especially supraspinatus tendon most commonly affected Calcification lies directly over the humeral head in crescentic distribution. it may be present symptomatic patents.

11. Carpi radialis in violinists and medial collateral ligament of the knee.( pellegrini steida lesion )

12. Parasites Ova of the pork tape worm , taenia solium are ingested by eating under cooked infected meat with the pig being the intermediate host. The embryo enters the blood stream and the parasites , cysticercosis cellulosa , becomes encysted within the soft tissues ,brain and meninges .

13. In muscles the parasites calcifies forming ellipsoids masses 10-15 mm long often with a translucent centre and which is lie in the direction of the muscle fibers . The guinea worm Dracunculus medinensis dies in the muscles and forms a spherical calcified mass or a long string like calcified worm 10-12 cm in length.( India,Africa,Middle East)

14. Loa loa or micro filariasis ,is a small parasite which is common in west Africa. it dies and calcifies appearing as coiled threads in the hands and feet. Armillilifer arnillatus is a parasite which infest snakes and infects human who eat them. it appears as C-shaped calcifications less than 1 cm in length in the serosa of the chest and abdomen.

15. Hydatid cysts in the soft tissues is rare Calcification in Metabolic disorders. Metabolic and metastatic calcification is the result of abnormal calcium and or phosphate metabolism, in particular any cause of hypercalcemia . commonly occurs in secondary hyperparathyroidism

16. Periarticular calcinosis develops as well as metastatic calcification in the soft tissues. This may be so extensive that layering of the calcium is seen. With treatment of hypercalcemia the soft tissue calcification may resolves . Periarticular and interstitial calcinosis may be seen with hypoparathyroidism .

17. Pseudohypoparathyroidism there may be punctate or nodular areas of soft tissue calcification . In pseudo pesudo hypoparathyroidism calcification of the skin ,sub cutaneous tissues ,fascia, planes and tendons is present in 30 -50 % of cases. other associations are calcification are the dentate nucleus ,Basal ganglia and cataract.

18. Calcification of the Pinna is a feature of alkaptonuria ,Addison's disease and frost bite with Gout deposits of calcium urate in the soft tissues form calcified , juxta -articular masses ,or tophi , with associated paraarticular erosions .

19. Calcification associated with Hematomas initially there is an increase in soft tissue density at the site of injury ,Although calcification is rare but may appear within a few days in children .It usually forms in the periphery of the hematoma ,at this stage an isotope bone scan will show increased uptake.

20. an associated periosteal reaction ,the resulting appearance can be difficult to differentiate from a parotseal sarcoma on the plain film . In neonates a sub periosteal bleed in the parietal bone results in a cephalhaematoma which later on calcifies .This slowly absorbs and disappears with time although an irregular bone density may persists for years.

21. Calcification with soft tissues necrosis. Necrosis of the soft tissues following injections and other forms trauma, frost bite and burns .Post traumatic fat necrosis results in coarse spheroid calcified masses . Frost bite typically affects the pinna . Burns occasionally calcify, particularly in children.

22. Calcinosis 1.Calcinosis circumsripta . 2.calcinosis interstitalis universalis or dermatomyositis . 3.Tumoural calcinosis .

23. Calcinosis circumscripta This is associated with scleroderma and ranauds disease .Dense areas of calcification develop in the hands and. There is loss of the soft tissues of the tips of the fingers and associated bone changes including acro - osteolysis .

24. Calcinosis interstitials universalis or dermatomyositis . there is degeneration of the collagen tissue resulting in diffuse subcutaneous plaques or nodules of calcium or reticular calcification often with overlying ulceration . In addition with progression ,calcified masses or sheets of calcium form in the deeper tissues and lie in the direction of the limbs .

25. There is normal calcium and phosphate metabolism those affected have pain and muscle weakness if progressive the disease may be fatal. In adults there is an association between dermatomyositis and malignancy . Ehler,s Danlos syndrome is hereditary disorder with findings including lax joints ,fragile and elastic skin and blood vessels , acro osteolysis and subcutaneous nodules

26. Tumoral Calcinosis Tumoral calcinosis typically presents in young african men with swelling ,which may be painful, around the large joints and predominantly affecting the extensors surfaces. The hips are the most frequently involved ,followed by the elbows and the shoulders .

27. Ossification. Myocitis ossificans . 1.Myocitis osificans progressiva. 2.post traumatic myocitis osificans 3.paraplegic myocitis ossificans.

28. Myocitis osificans progressiva . the progressive form myocitis ossificans is a hereditary disease commoner in boys . it presents with ossification of the perimuscular fascia within one year and is associated with many congenital bone lesions such as phalangeal and metacarpalhypoplasia of the thumbs and big toes .

29. the condition is usually fatal . in the limbs the appearance needs to be distinguished from parosteal sarcoma.

30. Post-traumatic myositis it results in a soft tissue mass which ossifies with a lacy pattern by 4-8 weeks. common sites are the elbow and knee. The ossification may resolves. Paraplegic myocitis ossificans . it develops in paraplegics within 3-4 weeks below the level of the paralysis. There is hetrotopic periarticular calcification and ossification around the joints particularly the hip with irregular plaques of bone forming .

31. Thank you