Ulutas Med J The Ulutas Medical Journal Ulutas Med J 2149-0430 2149-388X Hayriye Zehra Ulutaş 10.5455/umj.20171114024323 283352 Case Report Biophysics Tumoral Calcinosis Around the Elbow: Case Report https://orcid.org/0000-0001-7535-0812 Unlu Serkan Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 1 Sanli Bayram Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 1 https://orcid.org/0009-0007-6271-4171 Yildirim Ismail Okan Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 2 https://orcid.org/0000-0002-7802-880X Oner Serkan Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 2 https://orcid.org/0000-0002-3895-6708 Dogan Metin Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 2 https://ror.org/047xgg150 Department of Radiology, Malatya State Hospital, Malatya, Turkey https://ror.org/04asck240 Department of Radiology, Inonu University School of Medicine, Malatya, Turkey 27 12 2017 2017 3 4 85 87 04 11 2017 13 11 2017 22 11 2017 © 2017 The Author(s) 2017 https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the CC BY-NC 4.0 licence.

Tumoral calcinosis is a rare ectopic calcification seen around large joints. Large joints are seen in the hip, shoulder and elbow, and less frequently in the foot and ankle. It is unclear why the first two decades of life are caused by familial predisposing aphakia, as well as being seen more frequently. We presented Magnetic Resonance Imaging findings of the patient who presented with tumoral calcinosis elbow pain clinic. Tumoral calcinosis should be kept in mind in differential diagnosis when a mass with soft tissue periarticular calcification is seen in the vicinity of large joints.

 Tumoral calcinosis elbow MRG joint Funding information was not reported in the published version of this article. Introduction

Tumoral calcinosis (TC) is a rare ectopic calcification seen around large joints ( 1 ). Large joints are seen in the hip, shoulder and elbow, and less frequently in the foot and ankle ( 2 ). It is unclear why the first two decades of life are caused by familial predisposing aphakia, as well as being seen more frequently ( 3 ). We presented Magnetic Resonance Imaging (MRI) findings of the patient who presented with TC elbow pain clinic.

 Case Presentation

T1AG Sagittal T2AG Sagittal, PDW Coronal, and PDW SPIR Axial sequences were obtained in the patient who complained of elbow pain and who applied to the radiology department for MR extraction.

Calcification foci (Figs. 1, 2, 3 and 4) were observed in a number of different sizes, with T1AG axial and coronal, PDW coronal and PDW SPIR coronal sequences clustered together in a multitude of hypo intense periarticular assemblies. On direct radiographs it was confir- med that these lesions were the calcification center (Figs. 5 and 6).

, 2, 3 and 4. T1AG axial and coronal, PDW coronal and PDW SPIR axial sequences observed in various hypo intense varying sizes of periarticular in the elbow joint.

Figure 1: , 2, 3 and 4. T1AG axial and coronal, PDW coronal and PDW SPIR axial sequences observed in various hypo intense varying sizes of periarticular in the elbow joint.

and 6. An X-ray foci of calcification around the elbow joint are observed.

Figure 5: and 6. An X-ray foci of calcification around the elbow joint are observed. Discussion

TC shows periarticular localization, especially in regions under compression, in the form of masses that are not directly related to the neighboring joint space. There are white sand, bruise color and texture or calcification in the tissues ( 4 ). This calcification pathogenesis in the TC is due to trauma-dystrophy, or traumatism ( 5 , 6 ). Clinical symptoms such as pain and skin erosion can be seen in the TC ( 7 ).

The idiopathic form of TC is the family. Another form of TC is due to the high calciumphosphorus ratio seen in chronic renal failure ( 8 ). Diagnosis on CT can be made with radiographic findings and the medical story of the patient. Radio graphically; both TC and idiopathic renal insufficiency are secondary to calcification sites that cause multiple well-defined pavement stones. MRI is seen as hypo intense lesion in all sequences. Additionally, edema due to inflammation around pathological calcification is seen as a hyper intense signal in T2AG and Inversion Recovery (IR) sequences ( 8 , 9 ). Heterotopic ossification, calcific hemangiomas or lymphangiomas, calcified soft tissue calcification, paraosteal osteosarcoma and synovial osteochondromatosis. In synovial osteo chondromatosis loose body bodies may be calcified, but they are intraarticularly located. Clinical history of the disease and location of lesion are of great importance in differential diagnosis ( 7 , 10 ). TC should be kept in mind in differential diagnosis when a mass with soft tissue periarticular calcification is seen in the vicinity of large joints.

 References Oeggerli P, Maurer R, Kistler H. Tumoral calcinosis with superinfection and sepsis Schweiz Med Wochenschr 1991; 121 (38): 1387-139 Prahinski JR, Schaefer RA. Tumoral calcinosis of the foot. Foot Ankle Int 2001; 22: 911-913 Sledz K., et al., Tumoral Calcinosis of the Temporomandibular Joint: CT and MR Findings, AJNR 16: 782-785, Apr 1995 0195-6108 / 95 / 1604-0782 Yurdoğlu C., Özbaydar MU., Adaş M. et al. Familial tumoral calcinosis in three patients in the same family, Acta Orthop Traumatol Turc 2007; 41 (3): 244-248. Slavin RE, Wen J, Kumar D, Evans EB. Familial tumoral calcinosis. A clinical, histopathologic, and ultrastructural study with an analysis of its calcifying process and pathogenesis. Am J Surg Pathol 1993; 17: 788-802 Boskey AL, Vigorita VJ, Sencer O, Stuchin SA, Lane JM Chemical, Microscopic, and ultrastructural characterization of the mineral deposits in tumoral calcinosis. Clin Orthop Relat Res 1983; (178): 258-69. Kumara, Singh P, Dobhal H. Case of Recurrent Tumoral Calsinosis in a Young Female, World Journal of Endocrine Surgery, January-April 2013; 5 (1): 18-20 Steinbach LS et al., Tumoral calcinosis: radiologic-pathologic correlation, Skeletal Radiol (1995) 24: 573-578 Farzan M, Farhood AR., Tumoral Calcinosis: What is the treathment? Report of two cases of different types and review of the literature, Am J Orthop. 2011; 40 (9): E170-E176. Sledz K, Ortiz O, Wax M, Bouguot J, Tumoral Calcinosis of the Temporomandibular Joint: CT and MR Findings, AJNR: 16, April 1995