What is the most likely diagnosis? 
              
                - 53 year-old with discoloration of the fingers
 
              
                
              Radiographs of Both Hands
              
                - Gout
 
                - Cushing Disease
 
                - Hyperparathyroidism
 
                - Metastatic Malignancy
 
                - Calcinosis Circumscripta
 
              
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                  Answer:
               
              
                5. Calcinosis Circumscripta
                 
              
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              Calcinosis Circumscripta
                
              
              General Considerations
              
                - Punctate  calcifications resulting from the deposition of calcium hydroxyapatite crystals  in the skin and subcutaneous tissues
 
                - Most  often associated with scleroderma, dermatomyositis and/or Raynaud’s phenomenon
 
                - Occurs  most often in adult females (6:1 female:male)
 
                - Mostly  in the upper extremity, especially the fingers
 
                - One  of the manifestations of CREST syndrome