PMC5109727_01
Preoperative condition. The MRI T1 demonstrated a large ectopic calcification in the right shoulder (a, coronal planes; b, axial planes). The MRI T1 showed a large ectopic calcification in the left shoulder (c, coronal planes; d, axial planes).
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Magnetic resonance imaging (MRI) performed in another hospital revealed that there was an abnormal mass in the subscapular regions of each shoulder (Fig. 1).
Plain radiographs of the right shoulder (a) and the left shoulder (b) show the symmetric ectopic calcification. CT scan (d, coronal planes; e, axial planes) and 3-D image (c, anterior) show ectopic calcification in the bilateral shoulders. (f) 99 m Tc-MDP bone scintigraphy revealed the increased accumulation of radiotracer not only in the masses of the bilateral shoulders but also in the right buttock and thigh. CT scan (g, axial planes) and 3-D image (h, posterior) showed ectopic calcification in the right buttock and right thigh behind the greater trochanter.
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In addition, Tc-methylene diphosphonate (Tc-MDP) bone scintigraphy showed increased radiotracer uptake not only in the masses of the bilateral shoulders, which were previously known, but also in the masses of the right buttock and right thigh (Fig. 2).
Preoperative images of the patient show swelling in the bilateral shoulders, right buttock and anteromedial approach (a, b). Intraoperative images: (c) Ectopic calcification infiltrated the periarticular tissue of the right shoulder, particularly the rotator cuff and articular capsule; (d) Ectopic calcification was divided from the normal tissue in the left shoulder; (e) Ectopic calcification resected from the right buttock; (f) Ectopic calcification resected from the right shoulder; and (g) Ectopic calcification resected from the left shoulder. The scale bar represents 1 cm.
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In contrast, a complete excision was performed in the left shoulder and right buttock due to the clear boundary of the masses covered with velamen (Fig. 3).
(a, b) CT scan and 3-D image showed ectopic calcification in the right thigh behind the greater trochanter. Intraoperative images: (c) Ectopic calcification covering with velamen was divided from the normal tissue in the right thigh; and (d) Ectopic calcification resected from the right thigh. The scale bar represents 1 cm.
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During the operation, we found that the mass covered with velamen was divided from the normal tissue (Fig. 4), and the mass consisted of thick connective tissue and cavities filled with a toothpaste-like material.
CT scan (a, coronal planes; b, axial planes) and 3-D images (c, anterior; f, posterior) showed ectopic calcification in the right shoulder. MRI showed ectopic calcification in the right shoulder (d, coronal planes; e, axial planes). (g) Preoperative appearance of the swollen right shoulder. Intraoperative images: (h) Ectopic calcification infiltrated the periarticular tissue of the right shoulder; and (i) Ectopic calcification resected from the right shoulder. The scale bar represents 1 cm.
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Furthermore, an incomplete excision was performed twice over two surgeries (Fig. 5, Fig. 6).