An elderly male patient referred for a body computed tomography (CT) after incidental findings in the chest radiography that revealed unusual cutaneous calcifications. He had no specific complaints prior or at the moment of the CT. The laboratory data showed normal serum calcium, phosphorus, parathyroid hormone, and muscle enzyme levels.
Chest radiography revealed diffuse small subcutaneous calcifications (FIG.1).
Body CT also revealed diffuse small calcifications in the skin and subcutaneous tissues, with no muscle, vessel, or visceral organ invasion (FIG.2). No other relevant findings were apparent in the examination.
The final diagnosis was calcinosis cutis universalis, confirmed by skin biopsy.
Calcinosis cutis describes the deposition of calcium salts in the skin and subcutaneous tissue and can be divided into five main types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis [1,2]. Dystrophic calcification is the most common cause of calcinosis cutis and is commonly seen in patients with systemic sclerosis (up to 40% of patients), dermatomyositis and systemic lupus erythematosus, but can occur in other diseases that lead to connective tissue damage [2-5].
Clinically, it may present as a more circumscribed form - calcinosis circumscripta - usually affecting the fingers and periarticular regions or a more rarer form that is more generalized and severe - calcinosis universalis [2]. Dystrophic calcification is frequently painful, especially when the process involves areas close to joints or when ulceration is present, but it can occur gradually and be asymptomatic [2,4,5]. Unlike tumoral calcinosis, which presents as a mass-like calcification, calcinosis cutis is characterized by depositions of bands or sheets like symmetrical calcifications in skin, subcutaneous tissues and muscles [6].
The exact physiopathology remains unclear, and there are no clear guidelines of treatment; however, various treatments have been reported to be beneficial, usually with small and localized lesions being good candidates for surgical treatment, whereas more generalized disease will require medical management, namely warfarin, ceftriaxone, probenecid, diltiazem, aluminium hydroxide, colchicine or bisphosphonates [1-5].
When generalized calcinosis of the soft tissues is encountered, diagnosis as systemic sclerosis and dermatomyositis should be suspected. In the case of our patient, no underlying cause was apparent.
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From the chest X-ray (frontal and lateral views) (Figures 1, 2), symmetrical dense shadows can be observed in the bilateral shoulder girdle and subcutaneous tissues of the chest wall (indicated by arrows), appearing as band-like or patchy calcifications. Subsequent CT scans (Figures 3, 4, 5) further confirm that the calcifications are primarily located in the subcutaneous and superficial soft tissues, with no significant calcification in the muscle layer. The bony structures remain intact, with no signs of local bone destruction or fracture. In other areas visible on imaging, such as the pelvis and subcutaneous tissues of the buttocks, multiple small scattered or fused calcifications can also be observed.
Based on the imaging findings, laboratory results, and the absence of significant underlying disease, the most likely diagnosis is Idiopathic Calcinosis Cutis. Since the calcifications are widespread, they can be considered a generalized or “Calcinosis Universalis” form of cutaneous calcification. If any additional systemic symptoms arise or new lab abnormalities appear, further evaluation is advised to rule out underlying connective tissue diseases.
This report is based on the provided images and clinical information for reference purposes only and does not replace in-person consultation or professional medical advice. If you have any questions or if your condition changes, please seek medical attention promptly.
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