Calcifications

Abstract

Intra-abdominal calcification can be classified into four categories based on morphology: concretions, conduit wall calcification, cyst wall calcification, and solid mass calcification; it can also be divided based on anatomic location into four abdominal quadrants. This classification can aid with differential and, at times, the final diagnosis. Concretions are discrete precipitates within a vessel or organ; examples include the gallbladder (gallstones), urinary tract (renal, ureteral or bladder stones), diverticulum/appendix (fecalith, appendicolith), and pelvic veins (phleboliths). Conduit calcification refers to calcification within the walls of a fluid-filled hollow tube such as atherosclerotic plaquing of the abdominal aorta. When the wall of a cyst or hollow organ such as an aneurysm or the gallbladder (porcelain) calcifies, it becomes cyst wall calcification (smooth but curvilinear rim). Solid mass calcification (extensive but variable) includes mesenteric lymph node calcification, calcification of lymph nodes after an infection such as tuberculosis and leiomyoma. Structures like the costal cartilage, mesenteric lymph nodes, pelvic vein clots (phleboliths), and prostate gland may become calcified and still be of no clinical significance. On the contrary, calcification of the pancreas, kidney, blood vessels, gallbladder, uterus, urinary bladder, and appendix is considered pathological. In most circumstances, either diagnostic ultrasound or computed tomography (CT) will establish a definitive diagnosis and offer thorough imaging assessment for abdominal calcifications, with ultrasound being the test of choice for gallstones. A CT can help differentiate between urinary tract calculi (irregular with uniform density) and phlebolith (ovoid with lucent center), because the latter is clinically insignificant but the former is not. Some of the vascular calcification patterns include tram-track for non-aneurysmal, fusiform for aneurysmal, and calcification of tunica media for Monckeberg’s [medial] calcification.

What are the categories of calcification based on morphology?	Concretions, conduit wall calcification, cyst wall calcification, and solid mass calcification
How can calcification be classified based on anatomy?	Into four abdominal quadrants
Define concretions with examples.	Discrete precipitates; gallstones, renal, ureteral or bladder stones, fecalith, appendicolith, phlebolith
Give an example of conduit wall calcification .	Atherosclerotic plaquing of the abdominal aorta
What are the examples of cyst wall calcification ?	Aneurysmal calcification and porcelain gallbladder
Describe the usual pattern of solid mass calcification with examples.	Extensive but variable; normal lymph node or after infection such as TB and leiomyoma
Calcification of which structures is considered clinically insignificant on abdominal imaging?	Costal cartilage, mesenteric lymph nodes, pelvic vein clots (phleboliths), prostate gland
Name some structures, calcification of which is considered pathological on abdominal imaging?	Pancreas, kidney, blood vessels, gallbladder, uterus, urinary bladder, appendix
What is the best diagnostic imaging modality in general for assessing abdominal calcifications?	Ultrasound or CT
What is the imaging modality of choice for suspected gallstones?	Ultrasound
Which imaging modality can differentiate between phlebolith and renal/ureteric calculi?	CT
What are the characteristic features used to differentiate between phlebolith and renal/ureteric calculi?	Phleboliths are ovoid with lucent center; renal/ureteric calculi are irregular with uniform density.
What is Monckeberg’s [medial] calcification ?	Calcification of tunica media of medium-sized muscular vessels
Describe vascular calcification patterns .	Tram-track for non-aneurysmal; fusiform for aneurysmal