DR MOHAMMED MALIK AFROZ
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INTRODUCTION
DYTROPHIC CALCIFICATIONS
IDIOPATHIC CALCIFICATIONS
METASTATIC CALCIFICATIONS
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Idiopathic calcification (or calcinosis) – results
from deposition of calcium in normal tissue
despite normal serum calcium and phosphate
levels
Metastatic calcification – results when
minerals precipitate into normal tissue as a
result of higher than normal serum levels of
calcium
(e.g., hyperparathyroidism, hypercalcemia of
malignancy) or phosphate (e.g., chronic renal
failure).
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Metastatic calcification usually occurs bilaterally
and symmetrically
When the mineral is deposited in soft tissue as
organized, well-formed bone, the process is
known as heterotropic(extra skeletal)
ossification.
The causes range from posttraumatic
ossification, bone produced by tumors, and
ossification caused by diseases such as
progressive myositis ossificans and ankylosing
spondylitis
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DEFINITION – precipitation of calcium salts into
primary sites of chronic inflammation or dead and
dying tissue despite normal serum calcium and
phosphate levels.
ETIOLOGY – The soft tissue may be damaged by
blunt trauma, inflammation, injections, the
presence of parasites.
Process is usually associated with a high local
concentration of phosphatase, as in normal bone
calcification, an increase in local alkalinity(ph more
than 7), and anoxic (loss of oxygen) conditions
within the inactive or devitalized tissue.
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CLINICAL FEATURES – This calcification
usually is localized to the site of injury like
chronic cyst.
No signs or symptoms but may show
occasionally enlargement and ulceration of
overlying soft tissues may occur, and a solid
mass of calcium salts sometimes can be
palpated.
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Calcified lymph nodes
Calcification in tonsils
Cysticercosis
Arteriosclerosis
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varies from barely perceptible, fine grains of radiopacities to
larger, irregular radiopaque particles that rarely exceed 0.5 cm
in diameter.
One or more of these radiopacities may be seen, and the
calcification may be homogeneous or may contain punctate
areas.
The outline of the calcified area usually is irregular or indistinct.
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Lymohoid tissue is replaced by hydroxyapatite-like
calcium salts nearly effacing all of nodal architecture
ETIOLOGY – tuberculosis, BCG vaccination,
sarcoidosis, cat-scratch disease, lymphomas, fungal
infections, and metastases from distant calcifying
neoplasms.
CLINICAL FEATURES – discovered as an incidental
finding on a panoramic radiograph.
Most commonly involved nodes are submandibular
and cervical nodes (superficial and deep)
less commonly, the preauricular and submental
nodes.
When these nodes can be palpated, they are hard
round or oblong masses
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Location – The most common location
is the submandibular region, either at
or below the inferior border of the
mandible near the angle, or between
the posterior border of the ramus and
cervical spine.
Calcification may affect a single node
or a linear series of nodes as lymph
node chaining
PERIPHERY – The periphery is well
defined and usually irregular,
occasionally having a lobulated
appearance similar to the outer shape
of cauliflower.
Internal Aspect – vary in the degree of
radiopacity, giving the impression of a
collection of spherical or irregular
masses.
Occasionally the lesion has a laminated
appearance
MANAGEMENT – treat underlying cause
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Tonsillar calculi are formed when
repeated bouts (episodes) of
inflammation enlarge the tonsillar
crypts.
Incomplete resolution of dead
bacteria and pus serve as the nidus
(cause)for dystrophic calcification.
Clinical Features –
hard, round, white or yellow objects
projecting from the tonsillar crypts.
pain, swelling, fetor orisdysphagia,
and a foreign body sensation on
swallowing have been
reported with larger calcifications.
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LOCATION – In the panoramic
film, tonsilloliths appear as single
or multiple radiopacities that
overlap the mid – portion of the
mandibular ramus in the region
where the image of the dorsal
surface of the tongue crosses the
ramus in the palatoglossal or
glossopharyngeal air spaces
PERIPHERY – The most common
appearance of tonsilloliths is a
cluster of multiple small, illdefined radiopacities.
Rarely this calcification may attain
a large size.
Internal Structure – approximately
same radiodensity as cortical
bone.
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When humans ingest eggs or gravid proglottids from
Taenia solium (pork tapeworm), the covering of the eggs is
digested in the stomach and the larval form of the parasite
is hatched.
The larvae can enter any part of body but preferentially
locate to brain, muscle, skin, and heart.
CLINICAL FEATURES – Gastro – intestinal features like
nausea, vomiting and stomach pain.
Examination of the head and neck may disclose palpable,
well-circumscribed soft fluctuant swellings, which
resemble a mucocele.
Radiographic Features – NOT SEEN RADIOGRAPHICALLY
WHEN LARVAE ARE ALIVE
Location – muscles of mastication and facial expression,
the suprahyoid muscle, and the postcervical musculature
Periphery and shape – Multiple, well-defined, elliptical
radiopacities are viewed, resembling grains of rice.
INTERNAL STRUCTURE – Uniformly radiopaque
Two distinct patterns of arterial calcification
can be identified both radiographically and
histologically:
1. Monckeberg's medial calcinosis
2. calcified atherosclerotic plaque.
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DEFINITION – loss of elastic
fibers followed by the
deposition of calcium within
the medial coat of the blood
vessel.
Clinical Features – initially
asymptomatic but later may
develop cutaneous (skin)
gangrene, peripheral vascular
disease and myositis due to
vascular insufficiency.
Patients with Sturge-Weber
syndrome also develop
intracranial arterial
calcifications.
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LOCATION – Medial
calcinosis involving the
facial artery or, less
commonly, the carotid
artery, may be viewed on
panoramic radiographs
PERIPHERY AND SHAPE –
From the side the calcified
vessel appears as a parallel
pair of thin radiopaque lines
that may have a straight
course or a tortuous path PiPe stem appearance or
tram track appearance
INTERNAL STRUCTURE – no
internal structure
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Definition
Atheromatous plaque in the extracranial
carotid vasculature can be seen
Radiographic Features –
Location. Atherosclrosis first develops at
arterial bifurcations as a result of increased
endothelial damage at these sites.
When calcification has occurred, these lesions
may be visible in the panoramic radiograph in
the soft tissues of the neck adjacent to the
greater cornu of the hyoid bone and the
cervical vertebrae C3, C4, or the inter –
vertebral space between them.
Periphery and shape – These soft tissue
calcifications are usually multiple and irregular
in shape sharply defined from the surrounding
soft tissues and have a vertical linear
distribution.
Internal Structure – radiodensity ranging of
very mild to highly radiopaque
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