Cases reported "Calcinosis"

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1/15. Calcified left ventricular aneurysm and non-atherosclerotic myocardial infarction in a child.

    A 14-year-old boy, admitted with intractable chest pain, was found to have an enlarged heart and calcification in the apical region, with electrocardiographic features of massive inferolateral myocardial infarction. Left ventricular angiography revealed a large left ventricular aneurysm. He died following resection of the aneurysm and post mortem examination showed changes of a non-specific chronic myocarditis. A vasculitis involving small coronary arterioles was also found in the vicinity of the aneurysm, and the possibility of a rheumatic vasculitis was suggested by a transient episode of an erythema marginatum-like eruption. It is concluded that the association of infarction pattern on the electrocardiogram together with calcification of the heart in children is highly suggestive of a ventricular aneurysm secondary to a myocarditis or a vasculitis involving small, intramyocardial branches of the coronary arteries.
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keywords = arteriole
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2/15. A case of splenic lymphoma with marked diffuse nodular fibrosis and calcification, complicated with severe autoimmune hemolytic anemia.

    A splenic lymphoma, possibly of a splenic marginal zone lymphoma, marked by small nodular splenic calcified fibrosis and complicated by intractable autoimmune hemolytic anemia, was studied by immunohistochemical, molecular genetic, and ultrastructural analyses. The patient was a 57-year-old Japanese man who had moderate splenomegaly, and who had undergone splenectomy for improvement of severe autoimmune hemolytic anemia and to rule out malignancy in the spleen. In the resected spleen, proliferative atypical lymphoid cells were observed both in the red and white pulp with diminished germinal centers and irregularly widened marginal zones with peculiar dimorphic pattern. Ultrastructural study revealed no hairy cells or villous lymphocytes. Diffuse nodular hyalinous fibrosis surrounding the small arterioles in the white pulp overlapped with frequent calcification was a unique histologic feature in this case. Degenerative connective tissue, extracellular matrix, or collagen fibers surrounding the arterial sheath in the white pulp caused by some immunological abnormalities associated with this splenic lymphoma could be assumed to be the predisposing factor for this excessive fibrosis and dystrophic calcification in the spleen.
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keywords = arteriole
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3/15. Acute skin and fat necrosis during sepsis in a patient with chronic renal failure and subcutaneous arterial calcification.

    Calcification of small subcutaneous arteries and arterioles is commonly found in patients with chronic renal failure (CRF), but the syndrome of acute ischemic necrosis of the skin and subcutaneous fat supplied by these vessels is relatively uncommon. The necrosis occurs during dialysis and after successful renal transplantation, and it is often fatal. Occlusion of the calcified arteries and associated microvessels by thrombi is reported infrequently, but it is relevant to the necrosis. However, the pathogenesis remains enigmatic. In the patient described here, who had CRF, bacteremia, and laboratory evidence of disseminated intravascular coagulation (DIC), the distribution of thrombi and necrosis was mainly that of the calcified arteries which, therefore, probably played a role in the localization of the thrombi. An increased susceptibility of the endothelium of calcified vessels to the procoagulant effects of sepsis may be a contributing factor.
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keywords = arteriole
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4/15. calcium deposition in the skin of a hemodialysis patient with widespread skin necrosis.

    Rapidly progressive skin necrosis involving large areas of the skin associated with extensive vascular calcification was observed in a 39-year-old male patient on chronic hemodialysis. Histological examination of the periphery of a skin ulcer showed that subepidermal arterioles were occluded with fibrin deposits and that calcification was demonstrated in subcutaneous small arteries and arterioles. Electron microscopically, electron-dense materials, granular, crystal-like, vacuolar, or laminated, were found not only in arterial walls of the periphery of an ulcer but also, to a lesser extent, in those of normal-appearing skin. The skin necrosis gradually healed with antiseptic topical treatments and the injection of recombinant erythropoietin. The relationship between the vascular lesions in hemodialysis patients and progressive skin necrosis is not well known, although a combination of local and systemic factors may play an important role in the development of vascular calcification and skin necrosis in uremic and hemodialysis patients.
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ranking = 2
keywords = arteriole
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5/15. Quadrantic venous-stasis retinopathy secondary to an embolic branch retinal artery obstruction.

    Venous-stasis retinopathy is a term used to describe the posterior segment findings of the ocular ischemic syndrome. These include midperipheral blot retinal hemorrhages, dilated retinal veins, attenuated arterioles, peripheral retinal microaneurysms, macular edema, as well as retinal and optic disc neovascularization. The authors recently evaluated a 71-year-old woman who presented with an asymptomatic calcific embolus in her right infero-temporal branch retinal artery. Classic venous-stasis retinopathy that was limited to the territory of the obstructed arteriole was present concurrently. This case appears to demonstrate that chronic retinal hypoperfusion and resultant venous-stasis retinopathy can be produced by not only high-grade, fixed stenosis but also by embolic disease.
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ranking = 2
keywords = arteriole
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6/15. Digestive tract and renal small vessel hyalinosis, idiopathic nonarteriosclerotic intracerebral calcifications, retinal ischemic syndrome, and phenotypic abnormalities. A new familial syndrome.

    A new familial syndrome that affected 3 of 7 siblings is described. All 3 patients were young women with a very peculiar phenotype, poikilodermia and hair greying, and idiopathic nonarteriosclerotic cerebral calcifications. Pathological studies demonstrated a marked and progressive hyalinosis involving capillaries and often arterioles and small veins of the digestive tract, kidneys, and calcified areas of the brain. Using electron microscopy, we found that the hyalin substance in the intestinal capillaries consisted of several concentric layers of basal membrane-like deposits within a finely granular fluffy material. Huge deposits of this material were present in the subepithelial and mesangial spaces of the kidneys. endothelial cells and, in the kidneys, mesangial cells were markedly abnormal, and a true mesangiolysis pattern was present in 2 patients. The clinical and biologic expression of these vascular changes was variable. diarrhea, rectal bleeding, malabsorption, and protein-losing enteropathy were the main and lethal clinical problems in the proband. hypertension appeared in the early stage of a second pregnancy in 1 sister, and mild proteinuria was found in all 3 affected patients. Peripheral retinal ischemic syndrome and chorioretinal scars were found in the ocular fundi of both affected sisters of the proband. A subarachnoid hemorrhage, due to a right sylvian aneurism, also occurred in both sisters and was lethal in 1 sister. None of the known causes of distal vessel hyalinosis could be ascertained.
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ranking = 1
keywords = arteriole
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7/15. The vascular lesions associated with skin necrosis in renal disease.

    Three renal allograft recipients and one uraemic patient presented with skin necrosis. In all cases, the subcutaneous arteries and arterioles were narrowed or occluded by mural calcification with or without intimal fibrosis. A review of the literature shows that uraemic patients or allograft recipients with skin necrosis involving the trunk or thighs have a poor prognosis while recovery is common in patients with more peripheral lesions. The aetiology of the arterial lesions is unknown. Their relationship to renal disorders and/or hyperparathyroidism is uncertain and therapy remains unsatisfactory.
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keywords = arteriole
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8/15. Xeroradiographic observations in four patients with chronic renal disease and cutaneous gangrene.

    Cutaneous gangrene developed in four patients who had chronic renal disease that resulted in secondary hyperparathyroidism and systemic arterial calcification. Three of the four patients showed a unique pattern, by xeroradiography, of extensive medical calcification in subcutaneous arterioles. This noninvasive procedure demonstrated calcium in minute subcutaneous arterioles. parathyroidectomy, conservative local care, and skin grafting resulted in cure of the cutaneous ulcers in two of the four patients.
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ranking = 2
keywords = arteriole
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9/15. Subcutaneous microvascular (capillary) calcification. Another basis for livedo-like skin changes?

    A morbidly obese woman with acute renal failure, high serum phosphorus and slightly depressed serum calcium levels, developed areas of induration in the subcutis with associated livedo reticularis. Later, the subcutis became necrotic and the skin ulcerated. The arterioles, and notably widened occluded capillaries, were found to contain calcium and phosphorus as determined by energy dispersive spectrometry. x-ray diffraction of the subcutis in an early stage of this lesion showed that the mineral was most likely a poorly crystalline hydroxyapatite.
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ranking = 1
keywords = arteriole
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10/15. Necrotizing vascular calcinosis.

    The case of a 62-year-old woman with end-stage renal failure who developed necrotizing vascular calcinosis is reported. Histologically, classical vascular calcinosis of arterioles with fibrosis of the intima were found in the subcutis and in the deep dermis.
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keywords = arteriole
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