Case Author(s): Thomas Vreeland, M.D. / Henry Royal, M.D. , 2/8/95 . Rating: #D2, #Q5
Diagnosis: Metastatic Calcification
Brief history:
68 year old with chronic renal failure, chest pain, and
equivocal enzymes being evaluated to rule out myocardial
infarction.
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Full history/Diagnosis is available below
Diagnosis: Metastatic Calcification
Full history:
68 year old woman with diabetes mellitus, chronic renal failure
for seven years presented with chest pain and equivocal enzymes
was being evaluated to rule out myocardial infarction.
Radiopharmaceutical:
Tc-99m pyrophosphate
Findings:
Diffusely increased uptake is seen in both lung fields, the
myocardium, the stomach walls and the kidneys, bilaterally.
Discussion:
Diffusely increased uptake in the stomach, lungs, and myocardium
strongly suggest the diagnosis of metastatic calcification
associated with secondary hyperparathyroidism secondary to
chronic renal failure. Diffuse activity in the kidneys may
represent physiologic distribution of activity. Metastatic
calcification occurs in areas of "ion flux" which generate
an alkaline environment. The elevated pH will affect the
soluability coeffecient of calcium and phosphorous, resulting
in precipitation of amorphous microcalcifications. These areas
of microcalcification may not be visible on radiographs.
The diffusely increased activity in the myocardium may
represent only areas of metastatic calcification; however,
superimposed myocardial infarction cannot be excluded on this
examination.
Differential Diagnosis List
The differential diagnosis for diffusely increased myocardial
activity would include myocarditis, pericarditis, and diffuse
infiltrating diseases, such as amyloidosis or hemosiderosis.
ACR Codes and Keywords:
References and General Discussion of Myocardial Imaging (Anatomic field:Heart and Great Vessels, Category:Metabolic, endocrine, toxic)
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Case number: mi006
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