Calciphylaxis: The potential diagnostic role of radiologists

Abstract

Calciphylaxis is a deadly disease that is currently diagnosed through a skin biopsy of resultant necrotic lesions despite many cases lacking this characteristic finding. Recently, research has demonstrated the ability of various radiologic techniques to detect calciphylaxis and have promoted their capabilities in earlier diagnosis without tissue invasion. In this case, an obese 55-year-old female with end stage renal disease, and a long history of dialysis, complained of weeks of persistent abdominal pain that was accompanied by a mottled, lacey, net-like rash that resembled livedo reticularis. Computed tomography of the abdomen revealed extensive arterial calcification and subcutaneous calcium deposition. These radiologic findings, coupled to a high clinical suspicion, prompted treatment for suspected calciphylaxis. Remarkably, after 1 week the patient reported substantial improvement. Hopefully, this publication in conjunction with previous and future research will raise awareness on the role Radiologists can play in expediting the diagnostic process for a lethal disease, especially when a tissue biopsy is not a feasible option.

Calciphylaxis and Kidney Disease: A Review

“…41 The role of imaging in the diagnosis of calciphylaxis has garnered attention, particularly when biopsy studies are inconclusive or invasive procedures are not possible. [42][43][44] Plain radiographic findings that have been associated with calciphylaxis include presence of small-vessel calcification, and a netlike pattern of calcification. Of these, one study found that while the presence of vascular calcification had the highest sensitivity for calciphylaxis (89.2, CI = 73.0 -100), a netlike pattern of calcification exhibited the greatest specificity (89.9, CI = 82.7 -97).…”

Uremic Bilateral Breast Calciphylaxis: A Case Report and Literature Review

“…In addition, computed tomography of the abdomen may reveal extensive intra-abdominal vascular calcification and subcutaneous calcium deposition in patients with suspected calciphylaxis. Plain X-rays and ultrasonography have also been used to detect subcutaneous vascular calcifications [ 19 ].…”

Calcifilaxis

“…Como métodos complementarios de ayuda diagnóstica se utilizan el laboratorio, que muestra alteración en el metabolismo fosfocálcico, concentraciones altas de hormona paratiroidea e hipoalbuminemia, y las imágenes radiográficas, donde se observa la calcificación de los tejidos blandos 6 .…”