1/22. Localization of a bone imaging agent in a calcified hematoma.A patient with chronic renal failure and secondary hyperparathyroidism had iliac bone biopsy. The procedure was complicated by a soft-tissue hematoma, which had calcified. A 3-4-cm palpable mass was visible in the lower left abdominal wall. Intense uptake of 99mTc-HMDP corresponded with the location of the calcified hematoma in this patient.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/22. calciphylaxis treated with neurolytic lumbar sympathetic block: case report and review of the literature.BACKGROUND AND OBJECTIVE: calciphylaxis is a painful complication of end-stage renal disease and secondary hyperparathyroidism. Calcification most commonly affects skin and soft tissue of the lower extremities resulting in excruciatingly painful skin ulcers. Treatment involves correction of hypercalcemia and hyperphosphatemia, parathyroidectomy, and supportive measures. methods: The literature and the merits of neurolytic lumbar sympathetic blockade (LSB) for the treatment of pain associated with calciphylaxis are reviewed. CONCLUSIONS: The neurolytic LSB provided pain relief and is a treatment modality to be considered in managing the pain associated with calciphylaxis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
3/22. Spectrum of complications related to secondary hyperparathyroidism in a peritoneal dialysis patient.The index patient is a 23-year-old female with end-stage renal disease (ESRD) secondary to chemotherapeutic agents. Continuous cycling peritoneal dialysis (CCPD) has been the renal replacement therapy for the past 5 years since a failed cadaveric renal transplant. Past medical history was significant for diabetes mellitus, hypertension, anemia, bilateral subclavian vein thrombosis with superior vena cava syndrome, secondary hyperparathyroidism, leukemia (at age 8), and hyperlipidemia. On presentation, soft tissue nodules were noted in the anterolateral surfaces of the legs. After 3 months of continued low-calcium-dialysate CCPD, calcitriol, and oral phosphate binders, a 2 x 3 cm nodule was noted on the posterior aspect of the thorax at the scapula. The only complaint at this time was shoulder pain at the acromioclavicular joint. Radiological examination revealed a 3 x 4 cm soft tissue opacity in the superior segment of the left lower lobe laterally. Despite a prior subtotal parathyroidectomy, phosphate binders, and calcitriol, the parathyroid hormone levels continued to increase, with development of tumoral calcinosis, worsening renal osteodystrophy, and calciphylaxis. Computed tomography examination revealed extensive soft tissue calcification consistent with tumoral calcinosis. An ulcerative lesion (1 cm) developed on the lateral aspect of the upper thigh owing to warfarin necrosis versus calciphylaxis. At this time, the phosphate binder was changed from calcium acetate to sevelamer hydrochloride. Aggressive wound treatment and aggressive calcium and phosphate control added to the treatment regimen has resulted in healing of the single ulcer and a decrease in the size of the tumoral lesions. In conclusion, early recognition and aggressive treatment of calciphylaxis can result in reduced morbidity and mortality from calciphylaxis in ESRD patients.- - - - - - - - - - ranking = 3keywords = soft (Clic here for more details about this article) |
4/22. Complete resorption of massive soft tissue calcification in a hemodialysis patient after parathyroidectomy.Massive soft tissue calcification involving the abdomen of a dialysis patient is described. As the result of severe secondary hyperparathyroidism associated with intensive calcifications, the patient was disabled and confined to a wheelchair. Following parathyroidectomy, soft tissue calcifications resolved remarkably, symptoms were relieved and the patient was able to walk. Our patient presented an unusual site of soft tissue calcification in secondary hyperparathyroidism and showed an example of complete resorption of soft tissue calcification after parathyroidectomy.- - - - - - - - - - ranking = 8keywords = soft (Clic here for more details about this article) |
5/22. Parathyromatosis as cause of recurrent secondary hyperparathyroidism: a cytologic diagnosis.Parathyromatosis is a rare cause of hyperparathyroidism. It can be divided into two types: primary and secondary. The pathologic lesion consists of multiple small nodules of hypercellular parathyroid tissue strewn in soft tissue (fat, skeletal muscle, fibrous tissue) of the neck. We present a case of parathyromatosis occurring in a patient with recurrent secondary hyperparathyroidism 4 yr after parathyroidectomy. The diagnosis was confirmed preoperatively by fine-needle aspiration of one of several neck masses.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/22. Central giant cell granuloma.Central giant cell granuloma, a fibro-osseous lesion, is more commonly found in the mandible and mainly in children and young adults. The lesion, which has a greater incidence in females, may be uni or multilocular. On the basis of clinical, radiological and histologic features, central giant cell granulomas can be classified as "non-aggressive" or "aggressive". Management involves surgical removal and in most cases the dentition can be maintained. Three cases of central giant cell granuloma are reported and they illustrate clinical features of the lesion, how differential diagnosis can be assisted by ORAD (a special software program), treatment, and the importance of recall examinations.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
7/22. Brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism: CT and MR imaging findings.We present a case of brown tumor of the sphenoid sinus in a patient with secondary hyperparathyroidism. CT showed an expansile soft-tissue attenuation mass centered in the sphenoid sinus. CT at bone window setting demonstrated expansile, lytic change and remodeling of the surrounding bone. On MR imaging, the lesion showed iso-intensity to gray matter on T1-weighted images and heterogeneous hyperintensity on T2-weighted images, and showed intense enhancement. The extent of the lesion and its relationship to the surrounding structures were best evaluated by CT and MR imaging.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/22. calciphylaxis in a hemodialysis patient: appearance after parathyroidectomy during a psoriatic flare.Chronic renal failure patients are prone to soft tissue calcifications. A phenomenon of acute ischemic skin necrosis and dermohypodermic arteriolar medial calcification has been described recently in patients with chronic renal failure and secondary hyperparathyroidism (HPT). This phenomenon, termed calciphylaxis, occurs in response to certain factors, the most important of which appears to be an elevated blood calcium-phosphate product. Accordingly, parathyroidectomy in addition to normalization of calcium-phosphate product has been proposed as the only effective therapeutic approach for this condition. We describe a case of chronic renal failure with severe secondary HPT in which the patient developed calciphylaxis 4 days after the appearance of a psoriatic flare. Four months before, a subtotal parathyroidectomy was performed for severe HPT and at the time the ulcerations appeared, blood calcium-phosphate product was correct. Etiological and physiopathological aspects of calciphylaxis are discussed.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/22. brain calcification due to secondary hyperparathyroidism in a child with chronic renal failure.Secondary hyperparathyroidism (SHPT) has been better treated over the last decades, but the rate of metastatic calcifications, which were rarely seen before, was significantly increased in dialysis patients. The presence of uncontrolled SHPT, disorders of calcium (Ca) and phosphorus homeostasis and the common usage of large doses of vitamin d and Ca- containing phosphate binders may all contribute to the metastatic calcifications of soft tissues and vasculature leading to some life-threatening complications. Although the metastatic lung, heart, kidney, intestinal wall, skin, eye and soft tissue calcifications have been commonly reported in adults and also in children undergoing dialysis, the central nervous system calcification is a very rare condition. We report here a pediatric hemodialysis patient who presented with severe neurological findings due to the metastatic brain calcification secondary to his uncontrolled hyperparathyroidism.- - - - - - - - - - ranking = 2keywords = soft (Clic here for more details about this article) |
10/22. Fatal childhood calciphylaxis in a 10-year-old and literature review.calciphylaxis is a rare but highly morbid disorder of vascular calcification and skin necrosis, affecting 1% to 4% of adults with end-stage renal disease. Only three affected children have previously been described. We report an unusual instance of fatal calciphylaxis involving a 10-year-old boy, in the setting of sarcoidosis-induced end-stage renal disease. A review of pediatric calciphylaxis cases suggests: (a) increased risk in boys with end-stage renal disease and secondary hyperparathyroidism; (b) frequent distal extremity and visceral organ involvement, (c) worse prognosis with acral necrosis, and (d) possible increased resistance to medical treatment compared to adult patients. Hyperesthetic pain is a common sentinel symptom, and soft tissue x-rays or xeroradiography or both may aid in the diagnosis of pediatric calciphylaxis. parathyroidectomy in combination with supportive medical management may be the best treatment option in stopping the progression of disease in the pediatric population.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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