Ingested foreign body mimicking an appendicolith in a child

We describe an unusual case of a child who had ingested sand and stones and presented with signs and symptoms suggestive of appendicitis. Plain radiographs revealed calcific opacities in the right iliac fossa simulating appendicoliths. At surgery and histopathology a small sealed off perforation of the terminal ileum with hard concretions in the wall was observed.     

The significance of calcific valvular heart disease in Tc-99m pyrophosphate myocardial infarction scanning: radiographic, scintigraphic, and pathological correlation.

Technetium-99m pyrophosphate (PPi) is currently considered the best scanning agent for the diagnosis of acute myocardial infarction. False-positive scans have been reported in association with unstable angina, alcoholic cardiomyopathy, and ventricular aneurysms. In this study, 86% of patients (12/14) with either calcific aortic or mitral valvular heart disease had positive PPi cardiac scintiscans and the location of the PPi uptake was limited to the calcific valve in all (9/9) of the patients who underwent valve replacement surgery. Six patients with valvular disease without radiologic evidence of calcium had negative PPi heart images. Three of these patients had surgical valve replacement, and in none was there increased uptake in the resected valve. Seventy-five percent of the patients with calcified aortic valves had localization of the PPi activity to the area of the aortic valve, whereas 50% of the patients with calcified mitral valves showed a diffuse pattern of uptake on the cardiac image. In vitro demonstration of increased radioactivity in surgically removed cardiac valves warrants the conclusion that Tc-99m PPi is taken up by calcified heart valves. We conclude that while PPi heart scanning is a sensitive indicator of acute myocardial infarction, false-positive scans can occur in the presence of calcific valvular disease, due to localization of PPi in the calcified portion of the valve.     

The use of high-field magnetic resonance in the follow-up of patients with mechanic aortic valve prosthesis and composite aortic tubular prosthesis

Eleven patients who had undergone cardiac surgery were studied by means of high-field MR imaging (1.5 T). Six patients had had aortic root and valve replaced with a Bj?rk-Shiley (BS) composite tubular aortic graft prosthesis for acute dissection of ascending aorta. In the other 5 patients with rheumatic calcific aortic disease, the valve had been replaced with a BS prosthesis. As a whole, MRI studies were 14. Previous evaluations of magnetic field effects had seem carried out ex vivo on both BS valves and BS composite prostheses, on surgical ligation clips (Tantalium and Stainless) and on stainless wires for sternal closure. In 4 patients (2 BS composite grafts and 2 BS valves) MRI diagnosed chronic dissection of both arch and descending aorta. In 1 of them, with a BS valve, associated localized acute dissection of ascending aorta was observed. In 3 patients with BS composite grafts, MRI revealed pseudo-aneurysms (including a thrombosed one) at the graft level. In one case MRI was repeated 4 times and was very helpful in monitoring the pseudo-aneurysm. MRI showed pericardial hematoma in 2 patients with BS grafts and paravalvular abscess in a case with BS valve. In one patient with BS valve fast-imaging MR revealed severe aortic regurgitation. No adverse reactions were demonstrated on MR images of prosthetic implants. MRI artifacts were insignificant with the spin-echo technique, while the fast-imaging technique showed clear image distortion at the valve level.     

Arthroscopic treatment of chronic calcific tendinitis with complete removal and rotator cuff tendon repair

Relatively large calcific materials on radiographs of shoulders with persistent symptoms after extended periods of conservative treatment are candidates for operative treatment. But complete removal of calcific materials sometimes leaves a large defect in the rotator cuff tendon, and tendon repair might be essential if defects are large. We evaluated the clinical results of complete removal of calcific deposits with or without repair of the rotator cuff tendon in 35 consecutive patients. Eighteen patients underwent calcific material removal, which resulted in a complete tear in the rotator cuff tendon, and suture anchor repair. And the other 17 patients received either side-to-side repair or simple debridement. Clinical outcomes improved at a median 31 (range 24–45) months after surgery, and pain relief was achieved within 6 months of surgery in 30 of 35. However, ten patients developed a secondary stiff shoulder. Repair with or without suture anchor after complete removal of calcific material provides good clinical results and earlier pain relief when it was compared to previous literatures of minimal removal technique.     

Calcific cerebral arterial embolization in the setting of bacterial endocarditis superimposed on prior rheumatic aortic valvular disease

Stroke from a calcific cerebral artery embolus demonstrated by noncontrast computed tomography (CT) is rare. Although the ability of CT to demonstrate early acute cerebral emboli is limited, in the uncommon event of a calcific cerebral embolus, CT can easily visualize the embolized material. We present an unusual case of calcific cerebral arterial embolization to the proximal middle cerebral artery and illustrate the usefulness of CT in diagnosing this rare entity in conjunction with important predisposing clinical factors.     

Calcific tendonitis of the quadriceps

The case reported is of a 46 year old male who presented with a history of acute on chronic knee pain. The clinical features and investigations suggested a tear of the quadriceps tendon, with pre‐existing chronic calcific enthesopathy. The operative findings were of an acute collection of calcific material within the quadriceps tendon. This acute presentation and calcific collection have not previously been reported in the quadriceps tendon.     

Inflammation of vertebral bone associated with acute calcific tendinitis of the longus colli muscle

We present a case of acute retropharyngeal calcific tendinitis with characteristic findings on radiographic, computed tomography, and magnetic resonance imaging (MRI). To our knowledge, this is the first acute retropharyngeal calcific tendinitis report having inflammation of both the vertebra itself and the longus colli muscle diagnosed on MRI. In patients with neck pain, acute retropharyngeal calcific tendinitis should be kept in mind in the differential diagnosis, even if these patients had vertebral pathological signals on MRI.     

Acute retropharyngeal calcific tendinitis: a case report with unusual location of calcification

Retropharyngeal calcific tendinitis is an inflammatory process caused by calcium hydroxyapatite crystal deposition in the longus colli tendon of the prevertebral space, and it may mimic a retropharyngeal infection or abscess. The diagnosis of retropharyngeal calcific tendinitis will be made radiologically by the detection of calcifications anterior to C1–C3 and prevertebral soft tissue swelling. We present a case of acute retropharyngeal calcific tendinitis with an unusual location of calcification anterior to the C5–C6 disc.     

Acute coccydynia related to precoccygeal calcific tendinitis

Symptomatic deposits of calcium hydroxyapatite have been reported in various sites other than the shoulders or hips. Sudden-onset coccydynia can lead to the discovery of calcific deposition in the precoccygeal region. We present the case of precoccygeal calcific tendinitis in a patient with acute coccydynia.     

Calcific tendonitis of pectoralis major: CT and MRI findings

Objective The shoulder is the most common location for calcific tendonitis. Presentation of calcific tendonitis at other sites is unusual and may lead to diagnostic difficulty.Design and patients We report a case of calcific tendonitis of the pectoralis major insertion and describe the CT and MRI findings.Results and conclusion The presence of an associated cortical defect at the site of tendon insertion may lead to the incorrect diagnosis of neoplastic process.     

老年钙化性心脏瓣膜病的超声心动图表现

目的应用超声心动图研究老年钙化性心脏瓣膜病（CVHD）的特点。方法接受经胸超声心动图检查的9017例50岁以上患者,以二维、M型、彩色多普勒血流图检测CVHD,记录各瓣膜情况,结果共检出CVHD574例,检出率随年龄增加而升高;性别之间无显著性差异;主动脉瓣钙化多于二尖瓣,无冠瓣钙化多于左、右冠瓣;主动脉瓣瓣尖及二尖瓣瓣环钙化检出率高;钙化形态以3-10mm斑状钙化最多见;部分患者出现血流动力学改变;该病常伴随于高血压病、冠心病、主动脉硬化等疾病。结论超声心动图可检出CVHD钙化部位、大小、瓣膜狭窄及关闭不全程度,为CVHD早期诊断提供影像学依据。     

Calcific tenosynovitis associated with calcific myonecrosis of the leg: imaging features

 The findings with histologically proven calcific tenosynovitis of the tibialis anterior tendon associated with calcific myonecrosis are described. This case emphasizes the typical appearance of this unusual relationship such as peripheral plaque-like calcifications of the tendon sheath, fluid-calcium levels, presentation as painless mass, and calcification and liquefaction of muscle bundles.     

A syndrome of widened medullary cavities of bone, aortic calcification, abnormal dentition, and muscular weakness (the Singleton-Merten syndrome).

Two patients with clinical and radiological features similar to those of Singleton and Merten's patients are described. These patients exhibit features of a unique clinical syndrome of unknown etiology: generalized muscular weakness with secondary hip and foot deformities, progressive calcification of the thoracic aorta beginning in childhood, calcific aortic stenosis leading to heart failure, dysplasia of the teeth, poor physical development, osteoporosis, expanded medullary cavities of the metacarpal and metatarsal bones, and chronic psoriaform skin lesions.     

Compression of the right pulmonary artery by aortic aneurysms: CT demonstration

Two cases are presented in which compression of the right pulmonary artery by thoracic aortic aneurysm was demonstrated using dynamic CT. The patients initially presented with symptoms suggestive of pulmonary embolus and were found to have unilateral absence of perfusion on isotope lung scan. Computed tomography was useful in demonstrating pulmonary artery compression by aortic aneurysm as the cause in both cases, and in demonstrating an aortic dissection in one case.     

“Undiagnosed aortic coarctation with 2 simultaneous acute aortic syndromes: Intramural hematoma and mycotic aneurysm”

Acute aortic syndrome can be a fatal pathology if not diagnosed and managed early. Although acute aortic syndrome is more often a diagnosis of adulthood, it may occasionally afflict the pediatric patients. We herein present a case of a 5-year-old female that was discovered to have multiple acute and congenital aortic abnormalities after presenting to the emergency department with infectious symptoms and lower extremity pain. Acute aortic syndrome may not be a top differential consideration in children with acute chest pain; however, it is important to consider because delayed diagnosis and management can have fatal implications.     

A review of the plain abdominal radiograph in acute rupture of abdominal aortic aneurysms

The abdominal radiographs of 31 patients, each with a surgically proven rupture of an abdominal aortic aneurysm, were reviewed retrospectively. The following changes were noted: calcification of the aneurysm in 65%, a soft tissue mass in 67%, complete loss of one or both psoas outlines in 75%, complete loss of one or both renal outlines in 78%, renal displacement in 25%, and properitoneal flank stripe changes in 19%. Unilateral loss of the subperitoneal fat line occurred in one patient. Loss of the psoas, renal and properitoneal-fat lines are indicative of a large retroperitoneal fluid collection. In patients with acute or subacute intra-abdominal symptomatology, it is important to examine the radiograph with specific attention directed at these retroperitoneal fat planes. The diagnosis of a ruptured aneurysm may be made in 90% of patients, particularly in the presence of a calcific aortic rim.     

An autopsy case of unexpected sudden death due to rupture of a thoracic aortic aneurysm into the left lung

Ruptured aortic aneurysms present with various signs and symptoms depending on the site of rupture and bleeding, often causing sudden death; however, rupture into the lung with hemoptysis and blood aspiration is very rare. We report a case of unexpected sudden death due to blood aspiration from rupture of a thoracic aortic aneurysm into the lung. An 83 year old man, who had a past history of surgery for an abdominal aortic aneurysm about 17 years previously, was found dead on his bed with massive hemoptysis. Medico-legal autopsy revealed rupture of a thoracic aortic aneurysm into the left lung, causing massive blood aspiration. Tight, diffuse pleural adhesion and the vulnerable wall of an aortic aneurysm due to advanced atherosclerosis with active inflammation appeared to have predominantly contributed to the penetration of the ruptured aneurysm into the lung. This case suggests that long-term clinical follow-up and management are needed for a patient with aortic aneurysm, and that a ruptured aortic aneurysm should be taken into consideration to identify the source of bleeding for hemoptysis.     

Ultrasound guided aspiration of massive periarticular calcinosis in patient with scleroderma

Massive periarticular calcinosis is poorly understood process arising either primarily (tumoral calcinosis) or secondary to underlying medical conditions, including connective tissue disease, soft tissue sarcoma, and metabolic dysregulation. The calcific deposits can cause functional limitation, skin ulceration, and cosmetic deformity. Treatment of the calcific deposits depends on the underlying cause but can be problematic with resistance to surgical and non-surgical treatments. Here, we introduce a case of tumoral calcinosis secondary to scleroderma treated with ultrasound guided aspiration.     

Bilateral gluteus medius and minimus calcific tendonitis in a patient with previous bilateral calcific tendonitis of the shoulder: A case report

Calcific tendonitis of the gluteus medius and minimus tendons is a rare complication of hydroxyapatite deposition disease, with bilateral involvement even more so. Although patients can be asymptomatic, there is often an acute-on-chronic presentation of pain. We present a case of bilateral calcific tendonitis of the gluteus medius and minimus tendons on a background of previous bilateral rotator cuff calcific tendonitis in a middle-aged woman. This patient''s long-standing history of multi-focal involvement required a multidisciplinary approach between orthopedics, rheumatology, and musculoskeletal radiology for optimal management, requiring different treatment options for different affected sites.     

Calcific tendinitis of the gluteus medius tendon with bone marrow edema mimicking metastatic disease

A case of calcific tendinitis of the gluteus medius is presented. This report describes a patient with a history of breast cancer who had the combination of amorphous calcifications in the gluteus medius tendon and the MR finding of conspicuous bone marrow edema in the adjacent greater trochanter, prompting concern for metastatic disease. We present images from radiography, bone scanning, CT, and MR imaging. The unusual combination of findings in these studies should be considered conclusive for calcific tendinitis, and should not be confused with malignancy.