Diagnostic Imaging in Patient with Soft Tissue Calcification: Findings

Figure 1:
Anteroposterior radiograph of the pelvis.

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Findings/Diagnosis

The radiographs demonstrate diffuse sheetlike and tumefactive calcifications throughout the subcutaneous tissues, muscle and fascia of the pelvis and right hand.

The underlying bones and joint spaces appear normal.

Figure 2: Anteroposterior radiograph of the right hand.

The differential diagnosis for soft tissue calcification is extensive and includes metabolic disturbances (particularly of calcium and phosphate), trauma (e.g., injection sites, tissue necrosis, resolving hematoma), collagen vascular diseases, crystal deposition disease (e.g., gout, calcium pyrophosphate and hydroxyapatite deposition disease), parasitic infections and venous insufficiency.

This patient had a known diagnosis of dermatomyositis, supporting her radiographic findings.

She has been intolerant of multiple disease-modifying antirheumatic drugs for treatment of her disease.

Jennifer L. Demertzis, MD, is a musculoskeletal radiologist at the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis, Mo. She is excited to collaborate on this new feature in the journal and looks forward to seeing future cases contributed by readers.