Ultrasound of the Month Case 39

Clinical History •

62-year-old female presents with a slowly-enlarging mass at the medial aspect of the right foot

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The mass is not painful but the increasing size has resulted in skin breakdown and difficulty with wearing shoes

Ultrasound of the Month – Case 39

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Treatment

• While surgical excision was considered necessary due to the size of the lesion and worsening symptoms, pre-operative biopsy was requested to exclude malignancy and help in planning the surgical approach

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Diagnosis

• Pathologic review of the samples obtained demonstrated calcific material without evidence of neoplasm

• Final diagnosis: Calcium hydroxyapatite deposition disease

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Hydroyapatite Deposition Disease

• Characterized by the deposition of calcium phosphate crystals (predominantly hydroxyapatite) in the peri-articular soft tissues • Most commonly found within tendons (calcific tendinosis) and especially within the rotator cuff • Local ischemia, trauma, metaboklic, and genetic

• The etiology of these depositions is uncertain.

• Possible factors suspected include prior trauma, local ischemia and resulting soft tissue degeneration, metabolic factors, and a genetic predisposition.

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