Ossification of Soft Tissue and Periosteum


- See:
  - Diff Dx: Hypercalcemia
  - Diff Dx: HyperPhosphatemia
  - Approaches To Differential Diagnosis In Musculoskeletal Imaging: Soft Tissue Calcifications

- Discussion:
    - calcium hydroxyapatite can be deposited in periarticular soft tissues or within joints;
    - in either event the disease may be monoarticular or polyarticular;
    - periarticular disease affects men and women with equal frequency and occurs most commonly during the fifth to eighth decades;
    - intraarticular dz also affects adults, women more commonly than men;
    - crystals can be deposited within articular cartilage, the synovium, or joint capsule;
    - common location of periarticular crystal deposition is within tendons about the shoulder, and in this location
            the process is termed "calcifying tendinitis."

- Differential Dx: Soft Tissue Calcification;
    - Caffey's syndrome
    - dermatomyositis
    - dysproteinemias
    - idiopathic hypercalcemia
    - fibrodysplasia ossificans:
    - hyper p04
    - osteomyelitis
    - hypertrophic osteoarthropathy (ankles, knees, and wrist)
    - milk alkali syndrome;
    - myositis ossificans
    - pseudohypoparathyroidism:
    - psoriatic arthritis
    - reiter's syndrome
    - renal osteodystrophy
    - sarcoidosis
    - tumoral calcinosis
    - scurvey
    - vasculitis (phlebitis / polyarteritis nodosum)
    - vitamin a toxicity
    - vitamin d toxicity
    - calcific myonecrosis:
          - may result from undiagnosed compartment syndrome, peroneal nerve injury;
          - may occur years after the original injury;
          - most often presents as an enlarging mass in the anterior compartment of the leg;
          - radiographs may show plaque like calcifications and a well defined peripheral border of the mass;
          - following surgical biopsy, there is a high occurance of chronic draining sinuses and secondary infection;
          - references:
                - Calcific myonecrosis mimicking an invasive soft tissue neoplasm.  A case report and review of the literature.
  
- Calcification w/ in Soft-tissue Tumors:
    - cavernous hemangioma, with phleboliths
    - tumoral calcinosis
    - soft-tissue chondroma
    - synovial chondromatosis
    - secondary hyperparathyroidism
    - hypervitaminosis D
    - milk alkali syndrome;
    - ossification in deeper soft tissues may represent either myositis ossificans progressiva or myositis ossificans traumatica;
          - former is a genetic condition, whereas the latter frequently, is the result of trauma;
    - periosteal rxn & soft tissue calcification:
          - in contrast to that of adults, the child's periosteum is easily stimulated to form new bone and, depending on the
                nature of the process, new bone formation may be diffuse and may cause considerable disability



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 23, 2012 9:28 am