11.11 diff diag of soft tissue calcifications Flashcards
what are the mechanisms of calcifications
Dystrophic and metastic
Dystrophic calicification
- normocalcemic
- Dead, dying, diseased, damaged or degenerating tissue
- increase in local alkalinity
Metastatic calicification
- Hypercalcemic
- normal tissue
- hyperparathyroidism or any other disease that increases calcium levels
Calcified Lymph nodes
- prior infection of inflammation
- granulomatous disorders, deep fungal infection, lymphoma
- irregular, cauliflower-shaped
- solitary or chains
sioliths in the parotid
are never solitary, multiple will always exist
treatment of sialoliths
- depends on location, if it’s near the orifice, take it out
- -if it’s in the middle, settle the inflammatory reaction down, then excise
“chaining” (calcification of lymph nodes) will most likely occur in…
patients that have TB
what is the outline shape of sioliths?
smooth outline, solitary
the patient has sioliths and when they are getting ready to eat, they get a swelling. This happens bc the ducts are plugged and the salivary glands are stimulated, but can release all the saliva
chronic obstructive sialadenitis
Tonsilloliths
- Detrich’s plugs (?)
- they kind of look like parotid sioliths on radiographs, but more over the bone and underneath the mandibular canal and oropharyngeal airspace
- often these patients will often present with terribly bad breath
Rhinoliths
- foreign body rxn with granulomatous and necrotic tissue in the nose
- kids like to stick things up their nose (exogenous)
how far does the styloid process have to stick out to be considered pathologic?
past the soft tissue of the ear
types of calcified styloid processes
- elongated
- segmented
- pseudoarticulated
symptomatic patients with Eagles syndrome have what types of symptoms
- post-tonsillectomy
- throat pain, dysphagia, foreign body sensation
- pain on yawning
carotid artery syndrome
- no history of tonsillectomy
- carotidynia from mechanical irritation of sympathetic tissue in arterial wall
- external carotid artery: pain on turning head, otalgia, vertigo, tunnitus, otitis media
- internal carotid artery: terning head produces syncope (they faint)
Laryngeal cartilage calcfications
- don’t need to be treated
- triticeous (“grain of rice”) cartilage
- superior cornu of thyroid
- extraskeletal benign bone-producing neoplasm
- majority form in posterior dorsal tongue
- firm, asymptomatic, sessile masses
- radiopaque nodule with cortical rim and internal cancellous bone
- simple excision
intraoral osseous choristoma
- multiple, small round radiopacities with radiolucent centers
- superficial in skin
miliary osteomas
-don’t need treatment
- Hx of trauma
- hemorrhage organizes and mineralizes (follows the muscle fibers)
- patients may develop sever trismus
- calcification follows direction of muscle fibers
- surgical excision once osteoblastic phase is complete
Myositis ossificans
tape worm eggs eaten
Cysticercosis Cellulosae
complicastion of dermatomyositis, scleroderma and raynaud’s disease
-seen on the tips of the fingers
-Calcinosis cutis
CREST syndrome
ulcerating, calcinotic masses
-seen on timps of fingers and elbows
calcinosis of muscle and subcutaneous tissues
dermatomyositis
calcifications in metastases
prostate most common, also in lung, thyroid…
- unilateral nasal obstruction
- pain, epistaxis (nose bleed)
- fetid rhinorrhea
- post-nasal drip
antroliths
can be endogenous or exogenous
- intravascular thrombi (calcification within a vein)
- associated with hemangiomas
phleboliths
prominent high to low shunt
-cavernous hemangioma (phleboliths)
bullsete/targeted appearance
phleboliths, round bc they are veins in cross section
arterial calcifications
- Monckeberg’s medial calcinosis
- calcified atherosclerotic plaque
- arteriosclerosis caused by deposition of calcium around fragmented elastic fibers in medial coat -FREQUENT IN HYPERPARATHYROIDISM AND CHRONIC RENAL FAILURE
- radiographically looks like Pipestem/ Tram-track calcifications
- track treatment w/ serial radiographs to see decrease in number of calcifications
-Monckeberg’s medial calcinosis
what conditions are common in Monckeberg’s medial calcinosis?
frequent in hyperparathyroidism and chronic renal failure
- occurs in a mature plaque
- first and worst at vessel Bifurcations – due to turbulence in the area
- Site = Common Carotid, approx C3-C4 vertebrae or below Hyoid Bone
- will be irregular verticolinear radiopacities
Calcified Atherosclerotic Plaques
two syndromes assoc with calcified stylohyoid ligament:
a. )Classic Styloid Syndrom/Eagle’s Syndromepost-tonsillectomy
- throat pain, dysphagia, foreign body sensation, pain on yawning b.) Carotid Artery Syndrome no tonsillectomy
- pain on turning head, vertigo, otitis media = ECA -turning head causes syncope = ICA
post-tonsillectomy
-throat pain, dysphagia, foreign body sensation, pain on yawning
Classic Styloid Syndrom/Eagle’s Syndrome
no tonsillectomy
-pain on turning head, vertigo, otitis media = ECA -turning head causes syncope = ICA
Carotid Artery Syndrome
what is the common site for calcified atherosclerotic plaques?
common carotid, approx C3-C4 vertebrae or below hyoid bone
calcification of which part of the carotid artery produces fainting (syncope)?
Internal carotid artery, occurs when turning the head
- calcification of the Triticeous Cartilage bilateral on the Thyroid cartilage
- Look like a grain of wheat
- innocous, no treatment, and the Triticeous cartilage is prone to calcify
Laryngeal Cartilage Calcifications
- bone producing neoplasm most common on posterior Dorsal Tonge -firm, asymptomatic sessile mass
- Radiographically = nodule w/ cortical rim and internal cancellous bone -Treat= surgical excision
intraoral osseous Choristoma
-superficial on skin but show up radiographically as multiple, round radiopacities w/ radiolucent centers -pt might have history of cystic acne
Miliary Osteoma
myositis ossificans (bone forming in muscle)
- Hx of trauma
- hemorrhage organizes and mineralizes
- patients may develop severe trismus
- calcification follows direction of muscle fibers
- surgical excision once osteoblastic phase is complete
- tapewormxmt by food grown where animals defecate
- tapeworm settles into any tissue, but prefer Skeletal m. -WILL NOT SHOW UP UNTIL LARVAE HAS DIED (NONVIABLE LARVAE) -treat w/ Proziquonto
Cysticerosis Cellulosae
3 main calcifying Auto Immune disorders
a. ) dermatomyositis – calcinosis of muscle and subcutaneous tissue
b. ) Scleroderma-part of CREST syndrome, w/ ulcerating, calcinotic masses
c. ) Raynaud’s disease-poor circulation to extremities when even think of cold (excessive vasoconstriction
Calcifications related to Meniscal Replacements
- calcifications around the now unused Silastic and Proplast TMJ meniscus replacements
- device becomes brittle, fragments and causes foreign body response leading to a dystrophic calcification
miscellaneous soft tissue calcifications
- calcified scar
- calc hemangioma
- histoplasmosis
- coccidiomycosis
- filariasis
- soft tissue osteosarcoma
- nevoid basal cell carcinoma syndrome
