Ch.16 - Recognizing Abnormal Calcifications and Their Causes Flashcards
Rimlike calcifications imply what?
Calcification that has occurred in the wall of a HOLLOW viscus.
Examples of rimlike calcifications:
- Cysts.
- Aneurysms.
- Saccular organs such as the gallbladder.
Linear or tracklike calcifications imply:
Calcification that has occurred in the walls of TUBULAR structures.
Examples of tracklike calcifications include:
Walls of arteries and tubular structures such as ureters, Fallopian tubes, and vas deferens.
Lamellar (or laminar) calcifications imply:
Calcification that forms around a nidus inside a hollow lumen.
Examples of lamellar calcifications include:
- Renal calculi.
- Gallstones.
- Bladder stones.
Cloudlike, amorphous, or popcorn calcification:
Calcification that has formed inside of a solid organ or tumor.
Examples of amorphous or popcorn calcifications include:
- Calcifications in the pancreas.
- Leiomyomas of the uterus.
- Lymph nodes.
- Mucin-producing adenocarcinomas.
- Dystrophic soft-tissue calcifications.
Rimlike calcifications - Renal cyst - Remarks:
Thick and irregular calcifications, though uncommon, may indicate the presence of RCC.
Rimlike calcifications - Splenic cysts - Remarks:
May be a manifestation of hydatid cyst, old trauma, or prior infection.
Rimlike calcifications - Aortic aneurysms - Remarks:
Occurs more often in diabetics with advanced atherosclerosis.
Rimlike calcifications - Gallbladder - Remarks:
Associated with chronic stasis –> Called porcelain bladder for its gross appearance.
Linear or tracklike calcification - Walls of smaller arteries - Remarks:
Mostly seen in atherosclerosis accelerated by diabetes and renal disease.
Linear or tracklike calcification - Fallopian tubes or vas deferens - Remarks:
Usually accelerated by diabetes.
Linear or tracklike calcifications - Ureters - Remarks:
Uncommon occurrence described with schistosomiasis and rarely TB.
Laminar or lamellated calcifications - Kidney - Remarks:
Most calcified renal stones are composed of calcium oxalate crystals. Mostly form due to stasis or infection.
Laminar or lamellated calcifications - Gallbladder - Remarks:
Most calcified gallstones are calcium bilirubinate - They form due to chronic infection and stasis.
Laminar or lamellated calcifications - Urinary bladder - Remarks:
Most bladder calculi contain urate crystals - They form most often from outlet obstruction.
Study of choice in diagnosing uterine fibroids:
US.
Amorphous, cloudlike, or popcorn calcifications - Pancreas - Remarks:
Chronic pancreatitis - Frequently 2o to alcoholism.
Amorphous, cloudlike, or popcorn calcifications - Uterine fibroids (leiomyomas) - Remarks:
Degenerating fibroids calcify.
Amorphous, cloudlike, or popcorn calcifications - Mucin-producing tumors - Remarks:
Mucin-producing tumors of the ovary, stomach, or colon may calcify as can their metastases.
Amorphous, cloudlike, or popcorn calcifications - Meningioma - Remarks:
Benign, extra-axial brain tumor of older individuals that calcifies about 20% of the time.
RUQ - Rimlike:
Gallbladder wall - Chronic infection.
RUQ - Tracklike:
Hepatic artery - Atherosclerosis.
RUQ - Laminated:
Gallbladder - Gallstones.
RUQ - Amorphous:
Head of pancreas - Chronic pancreatitis.
LUQ - Rimlike:
Splenic cyst - Amebic infection.
LUQ - Tracklike:
Splenic artery - Atherosclerosis.
LUQ - Laminated:
Kidney - Renal stone.
LUQ - Amorphous:
Tail of pancreas - Chronic pancreatitis.
RLQ - Rimlike:
Iliac artery - Aneurysm of iliac artery.
RLQ - Tracklike:
Iliac artery - Atherosclerosis.
RLQ - Laminated:
Appendix - Appendicolith.
RLQ - Amorphous:
Uterus - Fibroids.
LLQ - Rimlike:
Iliac artery - Iliac artery aneurysm.
LLQ - Tracklike:
Iliac artery - Atherosclerosis.
LLQ - Amorphous:
Uterus/ovaries - Ovarian tumor.
4 distinct patterns of calcification:
- Rimlike.
- Linear (tracklike).
- Lamellar (laminar).
- Cloudlike (amorphous or popcorn).
Examples of structures that manifest as rimlike calcifications:
- Cysts.
- Aneurysms.
- Saccular organs.
Rimlike calcification in a cyst:
Relatively uncommon.
Cysts that may calcify:
- Renal cyst.
- Splenic cyst.
- Extraabdominal sites –> Mediastinal cysts (pericardial + peribronchial) + Popliteal cysts (Baker cysts).
Saccular organs that may calcify?
- Gallbladder –> Porcelain bladder.
2. Urinary bladder.
Why would a urinary bladder calcify?
- Schistosoma.
- Bladder cancer.
- TB.
Linear or tracklike calcification occurs in the walls of:
- Arteries.
2. Tubular structures.
Do walls of vein calcify?
NO - Walls of veins do NOT calcify –> In veins, long, linear thrombi or small, focal thrombi (PHLEBOLITHS) may calcify.
Calcification of Fallopian tubes and vas deferens is more often seen in?
Diabetics.
Ureter calcification is seen in?
- Schistosomias.
2. Rarely in TB.
Lamellar or laminated calcifications are usually called?
Stones or calculi.
How sensitive are conventional radiographs for displaying renal calculi?
They are only about 50-60% sensitive despite the fact that about 90% of renal calculi contain calcium.
What has replaced conventional radiographs in the search for renal and ureteral calculi and their complications?
UNENHANCED, multislice spiral CT (stone searches).
A negative CT stone search study has a negative predictive value of …?
98%.
Besides urinary tract calculi, CT scans detect …?
Symptomatic lesions in other organ systems in almost 1/3 of the patients in whom a stone search study is conducted.
Recognizing a calculus on a stone search study:
- The direct finding is a calcific density in the ureter, at the ureterovesical junction or in the bladder.
- Indirect findings include signs of obstruction such as dilatation of the ureter or intrarenal collecting system OR overall enlargement of the kidney and signs of inflammation such as perinephric stranding.
Only about …-…% of gallstones contain enough calcification to be visible on conventional radiographs.
10-15%.
Bladder stones usually develop secondary to …?
Chronic bladder outlet obstruction.
They are very prone to develop lamination.
Cloudlike, amorphous, or popcorn calcification is calcification that has formed inside of pancreas?
Chronic pancreatitis - Pathognomonic.
Other organs that can have cloudlike, amorphous, or popcorn calcification?
- Leiomyomas of uterus.
- Lymph nodes.
- Mucin-producing adenocarcinoma.
- Soft-tissue calcification.
What important pathologic structure may have rimlike calcification?
Solid masses that have rimlike calcification.
No matter the cause, the presence of calcification implies a process that is …?
Subacute or chronic.
Calcification of leiomyomas of the uterus?
Uterine fibroids or leiomyomas very commonly degenerate and calcify over time.
Lymph nodes calcification:
Can calcify anywhere in the body, mostly due to prior granulomatous infection such as old TB.
Mucin-producing adenocarcinomas of the stomach, ovary, and colon - Calcification?
Their metastases calcify.
Soft tissue calcification?
Can occur as a result of prior trauma or from deposition of crystal salts in the soft tissues.
Why is it helpful to identify the PATTERN of calcification?
It helps identify the structure in which it has formed.
Why is it helpful to find the anatomic location of the calcification?
Helps to identify the organ or tissue of origin.
Dystrophic calcification inside a solid structure (Hip) may look like …?
HETEROTOPIC OSSIFICATION.