The Case of Multiple Periarticular Masses on Bone Scan

[e-mail]

Introduction: Tumoral calcinosis is a rare disorder that was initially described as an arthropathy of calcium pyrophosphate dihydrate deposition. It tends to occur more predominantly in the periarticular location of the extensor aspects of the large joints. It is a benign familial metabolic dysfunction of phosphate regulation, resulting in high levels of phosphate in the plasma leading to calcific deposits of hydroxyapatite or amorphous calcium phosphate crystals into soft tissues. It can also result from other conditions such as renal failure, dialysis, and hypervitaminosis D.

Methods: The index case is a patient operated in 2019 for tumoral calcinosis of the right knee, now referred to our department with painless periarticular swellings of the right femur and right elbow. Biochemically, the patient was noted to have an elevated phosphate level, with normal calcium and parathyroid hormone (PTH) levels. Technetium-99m Methylene Diphosphate (^99mTc MDP) bone scintigraphy was undertaken, confirming the findings of tumoral calcinosis in the suspected sites, as well as identifying other sites of involvement.

Results: The use of bone scintigraphy has been proven to have a good sensitivity, and its ability to scan the whole body in one acquisition gives the modality the added advantage of identifying tumoral calcinosis skip lesions. This was well demonstrated with the above case where the patient was treated with multiple surgeries based on radiological findings which were isolated to the area of complaint. Bone scintigraphy was able to identify multiple skip lesions (inclusive of bone marrow involvement), which resulted in change of the management approach in the patient.

Conclusion: Bone scintigraphy is therefore highly recommended, especially in patient with tumoral calcinosis, as it is able to identify lesions both in the suspected and other (skip lesion) sites.

Publication History

Article published online:
25 May 2023