Radiological Case: Tumoral Calcinosis

Eric M Christiansen, MD; Shane Mallon, MD; Michelle M; Alan Pitt, MD; Jeremy Hughes, MD


Appl Radiol. 2021;50(3):53-55. 

In This Article

Imaging Findings

Cervical spine MRI demonstrated anterolistheses from C2 to C5 with resultant multilevel, severe, central canal stenosis and corresponding T2 signal abnormality of the spinal cord. Numerous lobulated T1 and T2 hypointense foci extended from the craniocervical junction to the mid-cervical spine with involvement of the posterior elements (Figure 1).

Figure 1.

Sagittal STIR MR showing multilevel anterolisthesis with resultant spinal cord compression and spinal cord signal abnormality. Prominent, lobulated T2 hypointense foci are noted (arrows) involving the posterior elements.

Shortly afterward, the patient decompensated, with hypertension, bradycardia, and acute decline in motor strength in all four extremities. The patient was resuscitated and CT of the head and cervical spine were performed in preparation for emergent surgical decompression.

This demonstrated the lobulated structures seen on the prior MRI to be of homogeneous layering calcific density (Figure 2).

Figure 2.

Axial (A), sagittal (B) and coronal (C) CT images demonstrate lobulated homogeneous calcified densities involving the craniocervical junction and the lateral and posterior elements of the upper cervical spine.

The patient underwent C1-C6 laminectomy, occipital-T3 posterior fusion and extensive debridement. Per the operative report, the cervical spine had erosive features and a calcified necrotic process identified in pockets of soft tissue throughout the neck. Multi-level lateral masses were eroded. The C1-C2 joint space was filled with pockets of "cheese-like" calcific material.