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.


Tc-99m pyrophosphate


Diffusely increased uptake is seen in both lung fields, the myocardium, the stomach walls and the kidneys, bilaterally.


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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