Sarah Razaq, Falak Nigar, Sakinnah Hussain Naqvi.
Ultrasonographic Diagnosis of Tumoral Calcinosis in End-Stage Renal Disease.
J Coll Physicians Surg Pak Jan ;28(8):640-2.

We report the case of a young 25-year male, a known case of end-stage renal disease (ESRD), undergoing irregular dialysis sessions, who presented with multiple swellings along the extensor surfaces of large joints of body including shoulders, sacrum, wrists and elbows. The swellings were initially painless, but later became painful on movements alone, were causing hindrance in movement and the sacral lump was causing difficulty in lying supine. On evaluation by laboratory investigations, he revealed borderline hyperphosphatemia and hypocalcemia. The patient was referred by the treating physician to radiology department for assessment and evaluation of the periarticular swellings. Musculoskeletal ultrasound revealed multiple, large, hypoechoic shadows in subcutaneous location around both shoulders, elbows, wrists and sacrum. The needle aspirate showed thick whitish liquefied material which revealed amorphous, basophilic, clumps of dystrophic calcification on cytology. He was on irregular treatment and dialysis sessions. He was diagnosed as a case of tumoral calcinosis on the basis of history, examination and investigations. He was recommended surgical excision of the large swellings which were causing hindrance in his activities of daily living. He was put on phosphate lowering drugs and diet. Regular hemodialysis sessions were scheduled, but the patient had a fast downhill course and died within a month of diagnosis of tumoral calcinosis.

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