Lectures

Abdominal Calcifications

by Hetal Verma, MD
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    00:01 So let?s talk a little bit about abdominal calcifications.

    00:05 There are many different types of calcifications that can be seen within the abdomen and it?s important to be able to differentiate between the different types.

    00:12 So there are different categories of calcifications which can be then categorized into different types.

    00:19 So let?s look at the different categories.

    00:21 There are rim calcifications which are seen most commonly in cysts.

    00:25 There are linear calcifications which are seen most commonly as vascular calcifications.

    00:30 There are laminated or sometimes called lamellar calcifications which most commonly represent stones.

    00:37 And then there are popcorn calcifications which usually represent carcinomas, uterine fibroids, pancreatic calcifications, lymph nodes, or dystrophic calcifications.

    00:47 So what is a rim calcification? It?s a calcification that?s seen within the wall of a fat, fluid, or air containing structure.

    00:56 Examples include as we said walls of cysts, gallbladder or urinary bladder walls, and vascular aneurysms.

    01:05 So let?s take a look at this image of the right upper quadrant of the abdomen.

    01:10 What do you see here? This is an 80-year-old asymptomatic female.

    01:13 This is an incidental finding that was seen on a radiograph.

    01:17 So we see calcification of the gallbladder wall.

    01:20 This may be confused with one large calcified stone, however, you can see that it?s actually a rim calcification and the inside of this is actually loosened which helps you differentiate this from a large stone.

    01:32 You can use CT to also help you differentiate.

    01:35 The diagnosis is porcelain gallbladder.

    01:40 So porcelain gallbladder has a very low association with gallbladder carcinoma.

    01:44 It essentially represents calcification of the wall of the entire gallbladder and because of this low association with gallbladder carcinoma, prophylactic cholecystectomy may be considered.

    01:54 So linear calcifications are calcifications that occur in the walls of linear structures that include arterial vascular calcifications, calcifications of the vas deferens, and calcifications of the fallopian tubes.

    02:09 For example, here?s a CT, an axial CT image and a frontal radiographic image.

    02:18 What do you think the circled finding represents? So this is an example of an aortic calcification.

    02:31 On the axial CT image you can see the entire wall of the aorta is calcified and on the frontal radiograph image you can see a tubular structure that has calcifications on both sides and this is an example of a calcified aortic wall.

    02:45 Laminated calcifications are calcifications that form from a nidus within a hollow structure.

    02:53 They are layers of calcified and non-calcified material that form around the central nidus so it?s kind of like looking at an onion, so you have multiple layers of calcifications just like you have multiple layers of an onion.

    03:06 Examples include renal stones, gallstones, and urinary bladder stones.

    03:13 So let?s take an example of this, this is a gallbladder.

    03:16 What do you see? What do you think the circled finding represents? So this is an example of multiple gallstones within the gallbladder.

    03:32 You can see how this looks a little bit different from the large calcified gallbladder that we saw in porcelain gallbladder.

    03:38 So this patient also has an incidental finding.

    03:41 What do you think the circled finding represents? This is actually an IVC filter which is placed in patients with DVT in the legs to prevent pulmonary embolism.

    03:58 This was just found as an incidental finding in this patient with gallstones.

    04:01 Popcorn calcifications are calcifications that form inside of a solid organ.

    04:08 Examples of these include pancreatic calcifications, calcified lymph nodes, and uterine fibroid calcifications.

    04:16 So let?s take a look at this, this is a coned down image of a pelvis that contains multiple calcifications.

    04:24 What do you think this could represent? So we can see one of them right here.

    04:36 This actually represents popcorn calcifications which are uterine fibroids.

    04:43 So let?s take a look at another example.

    04:46 What kind of calcifications are these in asymptomatic male with diabetes? Here?s the abnormality here.

    05:05 So these are linear calcifications that are present bilaterally within the pelvis.

    05:09 In a male with diabetes these represent calcified vas deferens.

    05:14 This is a very common incidental finding seen in males.

    05:18 Let?s take another look at a different type of calcification.

    05:24 So what do you think this calcification represents? Here?s the axial CT image of the same patient.

    05:39 You can see the calcification here and then what structure is this right here? So this is actually a bladder calculus.

    05:50 This is a laminated calcification that?s found within the urinary bladder and the structure here, this entire structure, is a fluid filled bladder.

    05:58 Here?s another example of a different type of calcification, so what do you see here? This is an asymptomatic patient that came in and was found to have an incidental finding.

    06:16 This is an axial CT image of the same patient, you can see the calcification right here and then you can see another one on the left, in the left kidney right here.

    06:30 So this is a right staghorn renal calculus.

    06:35 On the left we have another smaller renal calculus.

    06:37 And a staghorn calculus is one that involves the renal pelvis and at least 2 calyces, so you can see that this meets the definition of a staghorn calculus.

    06:46 In most patients, unless these are passed through the ureter, they?re asymptomatic.

    06:51 So we?ve talked about the various different calcifications that can be found within the abdomen and pelvis.

    06:59 We?ve gone over the different categories and the different examples from each category.


    About the Lecture

    The lecture Abdominal Calcifications by Hetal Verma, MD is from the course Abdominal Radiology. It contains the following chapters:

    • Rim and Linear Calcifications
    • Laminated and Popcorn Calcifications

    Included Quiz Questions

    1. Laminated
    2. Rim
    3. Linear
    4. Popcorn
    5. Microcalcification
    1. Rim - urinary bladder
    2. Linear - aorta
    3. Laminated - gallstones
    4. Popcorn - uterine fibroids
    5. Popcorn - lymph nodes
    1. Laminated
    2. Linear
    3. Porcelain
    4. Popcorn
    5. Rim
    1. Linear
    2. Popcorn
    3. Rim
    4. Laminated
    5. Mixed

    Author of lecture Abdominal Calcifications

     Hetal Verma, MD

    Hetal Verma, MD


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