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Calciphylaxis, also known as calcific uremic arteriolopathy, is an uncommon disease, typically found in patients with the end-stage renal disease. Pathophysiological features include small vessel vasculopathy with mural calcification, fibrosis, and thrombosis. The clinical presentation varies but often consists of the necrosis of skin and subcutaneous tissues, with or without visceral organ involvement due to small vessel vasculopathy. This condition has a significant morbidity and mortality, making accurate diagnosis imperative. We present a case of calciphylaxis investigated using planar bone scintigraphy and single-photon emission computed tomography-computed tomography (SPECT-CT). This case stresses the value of SPECT-CT to accurately localize the abnormal uptake in subcutaneous soft tissue microcalcifications and confirms the exact location and extent of pathology.

A 33-year-old woman with a diagnosis of Hodgkin's disease had a prechemotherapy whole-body Ga-67 scan to document gallium avidity of lesions and to assess response to therapy. A posttherapy scan showed a discordant response with complete resolution of lymphadenopathy and persistence of bone lesions. Radiographic evaluation of the left humerus, radius, and ulna demonstrated typical fibrous dysplasia as a cause for persistence of Ga-67 activity and shoulder activity probably representing arthropathy. She was in remission 3 years later although she fell and fractured the humerus through the bony lesion, and biopsy at the time of internal fixation confirmed fibrous dysplasia.