11.11 diff diag of soft tissue calcifications

Question 1

what are the mechanisms of calcifications

Answer 1

Dystrophic and metastic

Question 2

Dystrophic calicification

Answer 2

• normocalcemic
• Dead, dying, diseased, damaged or degenerating tissue
• increase in local alkalinity

Question 3

Metastatic calicification

Answer 3

• Hypercalcemic
• normal tissue
• hyperparathyroidism or any other disease that increases calcium levels

Question 4

Calcified Lymph nodes

Answer 4

• prior infection of inflammation
• granulomatous disorders, deep fungal infection, lymphoma
• irregular, cauliflower-shaped
• solitary or chains

Question 5

sioliths in the parotid

Answer 5

are never solitary, multiple will always exist

Question 6

treatment of sialoliths

Answer 6

• depends on location, if it’s near the orifice, take it out

- -if it’s in the middle, settle the inflammatory reaction down, then excise

Question 7

“chaining” (calcification of lymph nodes) will most likely occur in…

Answer 7

patients that have TB

Question 8

what is the outline shape of sioliths?

Answer 8

smooth outline, solitary

Question 9

the patient has sioliths and when they are getting ready to eat, they get a swelling. This happens bc the ducts are plugged and the salivary glands are stimulated, but can release all the saliva

Answer 9

chronic obstructive sialadenitis

Question 10

Tonsilloliths

Answer 10

• Detrich’s plugs (?)
• they kind of look like parotid sioliths on radiographs, but more over the bone and underneath the mandibular canal and oropharyngeal airspace
• often these patients will often present with terribly bad breath

Question 11

Rhinoliths

Answer 11

• foreign body rxn with granulomatous and necrotic tissue in the nose
• kids like to stick things up their nose (exogenous)

Question 12

how far does the styloid process have to stick out to be considered pathologic?

Answer 12

past the soft tissue of the ear

Question 13

types of calcified styloid processes

Answer 13

• elongated
• segmented
• pseudoarticulated

Question 14

symptomatic patients with Eagles syndrome have what types of symptoms

Answer 14

• post-tonsillectomy
• throat pain, dysphagia, foreign body sensation
• pain on yawning

Question 15

carotid artery syndrome

Answer 15

• no history of tonsillectomy
• carotidynia from mechanical irritation of sympathetic tissue in arterial wall
• external carotid artery: pain on turning head, otalgia, vertigo, tunnitus, otitis media
• internal carotid artery: terning head produces syncope (they faint)

Question 16

Laryngeal cartilage calcfications

Answer 16

• don’t need to be treated
• triticeous (“grain of rice”) cartilage
• superior cornu of thyroid

Question 17

• extraskeletal benign bone-producing neoplasm
• majority form in posterior dorsal tongue
• firm, asymptomatic, sessile masses
• radiopaque nodule with cortical rim and internal cancellous bone
• simple excision

Answer 17

intraoral osseous choristoma

Question 18

• multiple, small round radiopacities with radiolucent centers
• superficial in skin

Answer 18

miliary osteomas

-don’t need treatment

Question 19

• Hx of trauma
• hemorrhage organizes and mineralizes (follows the muscle fibers)
• patients may develop sever trismus
• calcification follows direction of muscle fibers
• surgical excision once osteoblastic phase is complete

Answer 19

Myositis ossificans

Question 20

tape worm eggs eaten

Answer 20

Cysticercosis Cellulosae

Question 21

complicastion of dermatomyositis, scleroderma and raynaud’s disease
-seen on the tips of the fingers

Answer 21

-Calcinosis cutis

Question 22

CREST syndrome

Answer 22

ulcerating, calcinotic masses

-seen on timps of fingers and elbows

Question 23

calcinosis of muscle and subcutaneous tissues

Answer 23

dermatomyositis

Question 24

calcifications in metastases

Answer 24

prostate most common, also in lung, thyroid…

Question 25

- unilateral nasal obstruction - pain, epistaxis (nose bleed) - fetid rhinorrhea - post-nasal drip

Answer 25

antroliths | can be endogenous or exogenous

Question 26

- intravascular thrombi (calcification within a vein) | - associated with hemangiomas

Answer 26

phleboliths

Question 27

prominent high to low shunt

Answer 27

-cavernous hemangioma (phleboliths)

Question 28

bullsete/targeted appearance

Answer 28

phleboliths, round bc they are veins in cross section

Question 29

arterial calcifications

Answer 29

- Monckeberg's medial calcinosis | - calcified atherosclerotic plaque

Question 30

- arteriosclerosis caused by deposition of calcium around fragmented elastic fibers in medial coat -FREQUENT IN HYPERPARATHYROIDISM AND CHRONIC RENAL FAILURE - radiographically looks like Pipestem/ Tram-track calcifications - track treatment w/ serial radiographs to see decrease in number of calcifications

Answer 30

-Monckeberg's medial calcinosis

Question 31

what conditions are common in Monckeberg's medial calcinosis?

Answer 31

frequent in hyperparathyroidism and chronic renal failure

Question 32

- occurs in a mature plaque - first and worst at vessel Bifurcations – due to turbulence in the area - Site = Common Carotid, approx C3-C4 vertebrae or below Hyoid Bone - will be irregular verticolinear radiopacities

Answer 32

Calcified Atherosclerotic Plaques

Question 33

two syndromes assoc with calcified stylohyoid ligament:

Answer 33

a. )Classic Styloid Syndrom/Eagle’s Syndromepost-tonsillectomy - throat pain, dysphagia, foreign body sensation, pain on yawning b.) Carotid Artery Syndrome  no tonsillectomy - pain on turning head, vertigo, otitis media = ECA -turning head causes syncope = ICA

Question 34

post-tonsillectomy | -throat pain, dysphagia, foreign body sensation, pain on yawning

Answer 34

Classic Styloid Syndrom/Eagle’s Syndrome

Question 35

no tonsillectomy | -pain on turning head, vertigo, otitis media = ECA -turning head causes syncope = ICA

Answer 35

Carotid Artery Syndrome

Question 36

what is the common site for calcified atherosclerotic plaques?

Answer 36

common carotid, approx C3-C4 vertebrae or below hyoid bone

Question 37

calcification of which part of the carotid artery produces fainting (syncope)?

Answer 37

Internal carotid artery, occurs when turning the head

Question 38

- calcification of the Triticeous Cartilage bilateral on the Thyroid cartilage - Look like a grain of wheat - innocous, no treatment, and the Triticeous cartilage is prone to calcify

Answer 38

Laryngeal Cartilage Calcifications

Question 39

- bone producing neoplasm most common on posterior Dorsal Tonge -firm, asymptomatic sessile mass - Radiographically = nodule w/ cortical rim and internal cancellous bone -Treat= surgical excision

Answer 39

intraoral osseous Choristoma

Question 40

-superficial on skin but show up radiographically as multiple, round radiopacities w/ radiolucent centers -pt might have history of cystic acne

Answer 40

Miliary Osteoma

Question 41

myositis ossificans (bone forming in muscle)

Answer 41

- Hx of trauma - hemorrhage organizes and mineralizes - patients may develop severe trismus - calcification follows direction of muscle fibers - surgical excision once osteoblastic phase is complete

Question 42

- tapewormxmt by food grown where animals defecate - tapeworm settles into any tissue, but prefer Skeletal m. -WILL NOT SHOW UP UNTIL LARVAE HAS DIED (NONVIABLE LARVAE) -treat w/ Proziquonto

Answer 42

Cysticerosis Cellulosae

Question 43

3 main calcifying Auto Immune disorders

Answer 43

a. ) dermatomyositis – calcinosis of muscle and subcutaneous tissue b. ) Scleroderma-part of CREST syndrome, w/ ulcerating, calcinotic masses c. ) Raynaud’s disease-poor circulation to extremities when even think of cold (excessive vasoconstriction

Question 44

Calcifications related to Meniscal Replacements

Answer 44

- calcifications around the now unused Silastic and Proplast TMJ meniscus replacements - device becomes brittle, fragments and causes foreign body response leading to a dystrophic calcification

Question 45

miscellaneous soft tissue calcifications

Answer 45

- calcified scar - calc hemangioma - histoplasmosis - coccidiomycosis - filariasis - soft tissue osteosarcoma - nevoid basal cell carcinoma syndrome