Citadel B. Rabanes, MD First Year JRRMMC- Department of Radiology

Calcifications

are discussed in terms of their position, orientation, shape, size, mobility, opacity, and chemical composition Categorized according to location, appearance, and relation to various pathologic conditions

Renal calcification 1. Nephrolithiasis 2. Nephrocalcinosis 3. Cyst or solid mass 4. Miscellaneous

Ureteral calcification Bladder calcification

Most

common cause of calcifications w/in the kidney Calcium mixed w/ oxalate, phosphate, or a combination of the two Causes: 1. disordered excretion of calcium, oxalate, and uric acid 2. Idiopathic

Radiopaque

calcium content Calcium oxalate stones: 1. Monohydrate- small, highly radiopaque 2. Dihydrate- spiculated or mamillated seed calculi- in caliceal diverticula milk of calcium- in epithelium-lined structure, in caliceal diverticulum, or in obstructed portion of the collecting system

FIG 1. SPICULATED CALCIUM STONE

FIG 2. MULBERRY STONE

FIG 3A. SEED CALCULI

FIG 3B. SEED CALCULI

FIG 4A. MILK OF CALCIUM STONES

FIG 4B. MILK OF CALCIUM STONES

Stone

particles (calcium carbonate)form urine-calculus level Staghorn calculus 1. calcium mixed w/ magnesium, ammonium, and phosphate 2. less opaque 3. Laminated Cystine stones- less radiopaque, grow quite rapidly

FIG 5. STAGHORN CALCULUS

FIG 6. CYSTINE STONE

Deposition

of calcium w/in the renal parenchyma Classified according to anatomic area involved: 1. Medullary nephrocalcinosis 2. Cortical calcinosis

Most

common form Uniform deposition of calcium: 1. Hyperparathyroidism 2. Distal renal tubular acidosis Asymmetric deposition of calcium: 1. Medullary sponge kidney- w/in papillary tips in dilated collecting ducts

FIG 8A.MEDULLARY SPONGE KIDNEY

FIG 8B. MEDULLARY SPONGE KIDNEY

Calcium

deposition in the renal cortex Secondary to: 1. Chronic glomerulonephritis 2. Acute cortical necrosis tramline appearance Spotty appearance Transplanted kidney- due to chronic rejection

Calcification

w/in a cyst wall occurs in approximately 3% of simple cysts Intracystic calcification 1. Thin and peripheral 2. eggshell appearance 3. Autosomal dominant PCKD Renal cell carcinoma- 20% calcifies Primary neoplasms (osteosarcoma of the renal capsule)

FIG11A. AUTOSOMAL DOMINANT PCKD

FIG 11B. AUTOSOMAL DOMINANT PCKD

FIG 12. RENAL CELL CARCINOMA

FIG 13. RENAL CELL CARCINOMA

Metastatic

lesions of the kidney Pattern of calcification of renal mass =likelihood of associated malignant disease 1. Pure central calcification- malignancy in 87% of cases 2. Pure peripheral calcificationmalignancy in 20% of cases

Renal

vasculature calcification- DM, hyperparathyroidism, atherosclerotic disease, renal artery aneurysm, AV malformation Dystrophic calcification- subcapsular hematoma Irregular calcification- sloughed papilla in papillary necrosis Amorphous calcifications- in the putty kidney of renal TB

FIG15. RENAL ARTERY ANEURYSM CALCIFICATION

FIG 16. VASCULAR CALCIFICATION IN DM

FIG 17A. SUBCAPSULAR HEMATOMA

FIG 17B. SUBCAPSULAR HEMATOMA

FIG 18A. SLOUGHED PAPILLA

FIG 18B. SLOUGHED PAPILLA

Stone 1. 1. 2.

that has migrated from the kidney giant ureteral calculus Stones impacted at points of anatomical narrowing Stones that form at sites of stasis w/in the ureter Ureteral diverticulum Ureterocele steinstrasse (stone street)- after ESWL

FIG 20A. URETERAL STONE FROM THE KIDNEY

FIG 20B. URETERAL STONE FROM THE KIDNEY

FIG 22A. CALCULUS IN URETEROCELE

FIG 22B. CALCULUS IN URETEROCELE

FIG 23A. DEVELOPMENT OF STEINSTRASSE

FIG 23B. DEVELOPMENT OF STEINTRASSE

Mistaken 1. 2.

3.

as ureteral stones: Phleboliths in the pelvis Phleboliths in the gonadal vein in the upper abdomen Silastic fallopian tubes band Ureteral wall cacificationsschistosomiasis, TB, amyloid infiltration, tumor

FIG 25A. GONADAL VEIN PHLEBOLITHS

FIG25B. GONADAL VEIN PHLEBOLITHS

Mixture

of calcium oxalate and calcium phosphate Radiopacity reflects their compositions Appearance: laminated, faceted, spiculated, or seedlike Stones due to urinary stasis- vesical diverticula 1. dumbbell stone

FIG 26. BLADDER CALCULI

FIG 27. DUMBBELL STONE

Calcification

w/in the bladder walltransitional cell carcinoma Tumor calcification- urachal carcinoma Mural calcification- schistosomiasis

FIG 28A. TRANSITIONAL CELL CARCINOMA

FIG 28B. TRANSITIONAL CELL CARCINOMA

FIG 29A. URACHAL CARCINOMA

FIG 29B. URACJAL CARCINOMA