W3 - Soft Tissue Calcifications - Amar Flashcards
What is heterotopic calcification?
When deposition of calcium salts occurs in an unorganised fashion
What is heterotopic ossification?
When deposition of calcium salts occurs in an organised fashion
3 Types of heterotopic Calcification
Dystrophic calcification
Idiopathic calcification
Metastatic calcification
What is dystrophic calcification?
Calcification that forms in degenerating, diseased and dead tissue, despite normal serum and phosphate levels
ex. calcified lymph nodes, atherosclerotic plaque
What is idiopathic calciification?
Results from deposition of calcium in normal tissue, despite normal serum and phosphate levels
Ex. Sialoliths
What is metastatic calcification + examples
When minerals precipitate into normal tissue as a result of higher than normal serum levels of calcium
Ex. Hyperparathyroidism, chronic renal failure
Radiographic features of dystrophic calcifications (site, size, appearance)
Common sites - long standing chronically inflamed cysts
Size - rarely more than 0.5 cm in diameter
Appearance - varies from fine radiopacity grains to larger irregular radiopacities
Why/where are calcified lymph nodes found?
Found in lymph nodes that have been chronically inflamed because of various granulomatous disorders
Such as pts with TB, cat-scratch disease, lymphoma treated by radiation therapy
Calcified lymph nodes
Clinical features of calcified lymph nodes (4)
- No significant signs or symptoms
- Most commonly in the submandibular region but can be anywhere on OPG
- Detected as incidental finding during OPG
- Upon palpation - may be single/multiple, mobile, hard, round, well-defined
calcified lymph node
calcified lymph node
What does the periphery of calcified lymph nodes look like?
Well-defined, irregular and lobulated
“cauliflower-like”
Management of calcified lymph nodes
Usually does not require tx.. BUT
Underlying cause should be determined
What are tonsilloliths and how are they formed?
Tonsillolith - incomplete resolution of dead bacteria and pus serve as the nidus for dystrophic calcification
Formed when repeated bouts of inflammation enlarge tonsillar crypts
Tonsillolith
Clinical features of tonsillolith
- Wide age group (20-68), more common in older age group
- Usually hard, white and yellow
- Asymptomatic if small
If large,
- Pain
- Swelling
- Halitosis
- Feeling of foreign body when swallowing
Tonsillolith
Tonsillolith
Periphery, shape and size of tonsillolith
- Clusters of multiple, small, ill-deined radiopacities
- Size varies from 5 - 15 mm
Multiple tonsilloliths on both sides
Managment of tonsillolith
Small - no tx
Large - refer to ENT for removal
2 patterns of arterial calcifications that can be identified radiographically
- Monckerberg’s medial calcinosis (arteriosclerosis)
- Calcified atherosclerotic plaque
Monckerberg’s medial calcinosis
- Calcific deposits in walls of artery, outline the artery
- Appears as a parallel pair of thin radiopaque lines
- “pipe stem” or “tram-track” appearance
- Extremely rare
Management of Monkerberg’s medial calcinosis and atherosclerotic plaque
Refer to GP or cardio-vascular surgeon for evaluation of arterial and vascular disease
Largest concern with calcified atherosclerotic plaque
If dislodges, can travel to brain and cause stroke
Where are the calcified atherosclerotic plaque most frequently found?
Found in the carotid vasculature (common carotid, external/internal carotid)
Close to which anatomical landmarks are you most likely to find calcified atherosclerotic plaque?
Between C3 and C4 is the birfurcation of the common carotid (most likely to see plaque)
Adjacent to the greater cornu of hyoid bone
Calcified atherosclerotic plaque
Describe the Periphery, shape and size of atherosclerotic plaque
Multiple and irregular in shape
Sharply defined
Vertical linear distribution
Heterogenous internal radiopacity
Why are Sialoliths common in submandibular glands?
- Gland and suct system lie in a dependent position
- Wharton duct is long and has an irregular tortuous course
- Duct runs upwards in an uphill flow
- Salivary secretion is more viscous and has higher mineral content
Clinical features of sialolith (4)
- History of pain and swelling of floor of mouth and involved gland
- May be asymptomatic at the time (saliva has drained, and no longer has pressure)
- Discomfort may increase around meal-times due to increase in salivation
- Duct orifice may be inflamed, tender, pus or ulcerated
What has more severe symptoms - intra or extra glandular types of sialolith
Extraglandular type
Sialolith
sialolith
sialolith
How do sialoliths appear radiographically?
Cylindrical
Cigar-shaped
homogenous radiopacity
Why must you reduce the exposure to visualise sialoliths?
Most sialoliths are radiolucent due to low mineral content
Sialolith
Sialolith
Sialolith in right submandibular gland
Differential dx: calcified lymph node (however its not cauliflower shaped or heterogenous radiopaque)
will require signs, symptoms and history to actually distinguish from differential dx
Sialolith in right parotid gland and duct
*extremely rare
Diff dx: tonsillolith, enostosis
Describe the radiography technique of observing sialoliths in the parotid gland duct
Film placed in the buccal vestibule, with reduced exposure and time
Central ray directed through the cheek
