Soft Tissue Calcification, Paraspinal



Soft Tissue Calcification, Paraspinal


Julia Crim, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Heterotopic Ossification



    • DISH


    • Spinal Muscle Injury, Traumatic


    • Post-Operative Change, Normal


    • Neurogenic (Charcot) Arthropathy


  • Calcification



    • Calcific Tendinitis, Longus Coli


    • Osteomyelitis, Granulomatous


Less Common



  • Heterotopic Ossification



    • Spondyloarthropathy, Seronegative


    • Osteosarcoma


  • Calcification



    • Schwannoma


    • Polymyositis/Dermatomyositis


    • Spondyloarthropathy, Hemodialysis


    • Juvenile Idiopathic Arthritis


Rare but Important



  • Fibrodysplasia Ossificans Progressiva (FOP)


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Heterotopic ossification: General term meaning bone forming outside normal sites



    • Myositis ossificans: Heterotopic ossification forming in muscles


    • Causes: Trauma, surgery; paraplegia


Helpful Clues for Common Diagnoses



  • Heterotopic Ossification



    • Over time, forms cortex and internal trabeculae



      • In osteosarcoma, structure lacking


    • DISH, seronegative spondyloarthropathy: Ossification of paraspinous ligaments follows ligament contour


    • Charcot arthropathy: Combination of florid periosteal new bone and small bone fragments in soft tissues



      • Usually more exuberant and disorganized than post-traumatic heterotopic ossification


      • “5 Ds” of Charcot joint: Preserved or increased density, bone debris, destruction, joint distention, joint dislocation


  • Calcification



    • Calcific tendinopathy of longus coli: Linear calcification associated with longus coli muscle edema, often fluid collection


    • Hydroxyapatite, gout, or scleroderma: Amorphous or globular


    • Calcium pyrophosphate deposition disease: Linear


    • Granulomatous infection: Irregularly shaped, associated with abscess


    • Polymyositis: Fine, reticular pattern along fascial planes


Helpful Clues for Less Common Diagnoses



  • Juvenile Idiopathic Arthritis



    • Periosteal new bone or ligament ossification






Image Gallery









Coronal bone CT shows post-traumatic ossification image in paraspinous fat. Mature bone architecture distinguishes it from osteosarcoma.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Soft Tissue Calcification, Paraspinal

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