Learning objectives
To present a series of challenging cases of unusual abdominal calcifications on plain film and their CT imaging correlation.
To discuss the pathophysiology,
epidemiology,
differential diagnosis,
treatment,
and complications of the cases presented.
To review the pattern and the imaging characteristics in order to narrow the differential diagnosis.
Background
The abdominal plain radiograph continues to be the initial imaging study to evaluate the abdomen,
since it is an accessible,
inexpensive and fast diagnostic method.
Pathologic calcification is the deposition of calcium in any tissue other than osteoid and enamel.
It can arise in tissues with unstable metabolism,
decreased blood supply,
inflammation,
trauma or infection.
Dystrophic calcification is the most common type,
it arises in damaged or necrotic tissues,
aging,
and malignancy.
In the other hand,
metastatic calcification is the result of systemic mineral imbalance...
Findings and procedure details
Findings and differential diagnosis?
ENCRUSTATED PYELONEPHRITIS
Chronic inflammatory process caused by crystal deposits from urea-producing organisms.
Corynebacterium urealyticum is the most common associated organism.
Risk factors:
Transplanted/ immunocompromised patients.
Urological surgery/ damaged urothelial mucosa.
Previous antibiotic therapy.
Imaging findings:
Most affected anatomic regions: the trigone,
ureters,
and bladder neck.
Abdominal plain film
Calcification in the wall of the collecting system,
ureter or bladder.
Staghorn calculus association.
CT
Non-contrast CT is the most sensitive diagnostic tool for urothelial calcifications (Fig. 2).
Ultrasound
Thickened and calcified urothelium...
Conclusion
Abdominal calcifications in plain films can be challenging.
There are many unusual conditions that may be associated with calcifications that may mimic other more common etiologies.
Therefore,
it is fundamental that radiologist consider other possible causes of abdominal calcification and become familiar with their imaging features and differential diagnosis.
Finally,
radiologist must keep in mind that when the etiology of an abdominal calcification is not clear on plain film,
the use of Computed Tomography is imperative for better characterization of this finding.
References
Stewart VL ,
Herling P,
Dalinka MK.
Calcification in Soft Tissues.
JAMA J Am Med Assoc.
1983;250(1):78.
Agarwal A,
Yeh BM,
Breiman RS,
Qayyum A,
Coakley F V.
Peritoneal Calcification: Causes and Distinguishing Features on CT.
Am J Roentgenol.
2004;182(2):441–5.
Cappuccino L,
Bottino P,
Torricella A,
Pontremoli R.
Nephrolithiasis by Corynebacterium urealyticum infection: Literature review and case report.
J Nephrol.
2014;27(2):117–25.
Nebreda-Mayoral T,
Muñoz-Bellido JL,
Garcia-Rodríguez JA.
Incidence and characteristics of urinary tract infections caused by Corynebacterium urealyticum (Corynebacterium group D2).
Eur J Clin Microbiol...