Heterotopic ossification: radiological and pathological review

Mujtaba, Bilal; Taher, Ahmed; Fiala, Matthew J.; Nassar, Sameh; Madewell, John E.; Hanafy, Abdelrahman K.; Aslam, Rizwan

doi:10.2478/raon-2019-0039

Cited by 64 publications

(71 citation statements)

References 98 publications

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“…Patients presenting with HO typically complain of inflammatory symptoms including pain, swelling, erythema, and warmth along with joint immobility typically appears as a recurrent or nonhealing ulcer. [4] Calcium extrusion may be observed, and large sheets of woody subcutaneous tissue may be palpable and should alert about the presence of a Heinz-Lippmann disease.…”

Section: Discussionmentioning

confidence: 99%

Heinz-Lippmann disease as an underrecognized cause of chronic venous insufficiency-associated cutaneous ulcers: Clinical and imaging findings

Toll

Marsico

Duitama

et al. 2020

Radiology Case Reports

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Venous insufficiency is a frequent cause of consultation in primary care settings. Heterotopic ossification, consisting of an abnormal formation of true bone in extraskeletal soft tissues, is an underrecognized complication of chronic venous insufficiency that may cause torpid ulcers. We report a case of 78-year-old woman, with a long-standing history of venous insufficiency and tibial fracture, showing a non-healing ulcer associated with subcutaneous calcifications of the left lower extremity. Gold standard of imaging diagnosis are both plain radiographs and computed tomography but also magnetic resonance imaging could be useful for assessing the characteristics of the pathology. We describe a case of Heinz-Lippmann disease, diagnosed by using both computed tomography and magnetic resonance imaging.

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Section: Discussionmentioning

confidence: 99%

Heinz-Lippmann disease as an underrecognized cause of chronic venous insufficiency-associated cutaneous ulcers: Clinical and imaging findings

Toll

Marsico

Duitama

et al. 2020

Radiology Case Reports

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show abstract

“…The most common causes of dystrophic calcification are soft tissue trauma and inflammation. As the disease progresses, calcified tissues begin to organize and ossify over the course of months into lamellar bone [13]. These heterotopic calcifications and ossifications suggest that these lesions are end-stage damage following high-dose radiotherapy [14], proving that these tissues should be completely excised and covered with highly vascularized axial pattern flaps.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

et al. 2020

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Background: Breast cancer patients who receive radiotherapy for postoperative tumor control are exposed to the possibility of adverse effects including osteoradionecrosis and ulceration. The purpose of this study is to explore reconstruction of ulcers according to their characteristics, and also to investigate the incidence of skin ulcers in patients who had undergone radiotherapy after modified radical mastectomy (MRM).Methods: Data of patients who underwent radiation therapy after MRM from 1979 to 2003 were collected. Demographics and radiation details were analyzed along with their reconstruction outcomes and pathologic characteristics. Effects of surgical debridement and reconstruction strategies for success were also assessed.Results: A total of 113 patients had radiotherapy after MRM in our institution, out of which nine patients (7.96%) developed ulcerations in the chest wall. Eleven patients underwent reconstructive surgery, including the nine patients who developed chest wall ulcerations and an additional two patients from other hospitals. Seven patients had thoracoepigastric flaps while three had latissimus dorsi musculocutaneous flaps and one had a perforator flap. The average initial wound size was 5.77 cm<sup>2</sup>, and this average was enlarged by 23.6 times after debridement. There was no reconstructive failure in any of the patients. Fibrosis, necrosis with ulceration, and dystrophic calcification were common pathological findings. Dystrophic calcification was found in seven of 11 cases. Additionally, ossification with bone formation was noted in three of seven cases with dystrophic calcification.Conclusion: A thorough preparation of the wound bed and reconstruction with flaps appropriate for the defect can successfully treat chronic radiation-induced ulceration.

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“…Such processes can be divided into two major etiologies, hereditary and acquired HO (1). Acquired HO is recognized as a common complication of musculoskeletal and/or neurogenic trauma, surgery and burns (2). Acquired HOs are generally wellreported and history of trauma as the initiating event is present in most cases, with the remaining cases of HO thought to be initiated by unrecognized microtrauma or repetitive mechanical stress (3).…”

Section: Titlementioning

confidence: 99%

Heterotopic ossification: radiological and pathological review

Cited by 64 publications

References 98 publications

Heinz-Lippmann disease as an underrecognized cause of chronic venous insufficiency-associated cutaneous ulcers: Clinical and imaging findings

Heinz-Lippmann disease as an underrecognized cause of chronic venous insufficiency-associated cutaneous ulcers: Clinical and imaging findings

Incidence and Reconstruction of Chronic Radiation-Induced Chest Wall Ulceration in Postoperative Breast Cancer Patients

Massive intracapsular heterotopic ossification of the anterior ankle joint after talar neck fracture: An unusual case study

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