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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
    • Calcinosis
    • Raynaud's phenomenon
    • Esophageal dysmotility
    • Sclerodactyly
    • Telangiectasia

Clinical Findings

  • Small, localized hard masses in the fingers
  • Skin may be tight, thickened with loss of normal skin folds
  • Painful ulcerations at ends of digits

Imaging Findings

  • Well-circumscribed calcifications in the soft tissues, frequently peri-articular
  • Hands may also demonstrate resorption of the terminal phalanges (acro-osteolysis)
  • Soft tissue atrophy of the tufts (sclerodactyly)

Differential Diagnosis

  • Tophaceous gout
  • Chronic renal disease
  • Idiopathic tumoral calcinosis
  • Milk-alkali syndrome
  • Hypervitaminosis D

Calcinosis Circumscripta

Calcinosis Circumscripta in Scleroderma. Radiographs of both hands show multiple, punctate calcifications (circles) in the soft tissues of both hands characteristic of calcinosis circumscripta. The patient had a 12 year history of scleroderma.
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JH Klippel, LJ Crofford, JH Stone, CM Weyand. Primer on the Rheumatic Diseases12th Edition 2001; 353-367.