Tumoral Calcinosis and Systemic Sclerosis
A 65-year-old female with a history of progressive systemic sclerosis presented with left shoulder and bilateral external ear pain. Physical exam revealed, tender nodular calcium deposition in both ears, a hard, tender, erythamatous, anterior bulging mass of the left shoulder and sclerodactyly. A chest radiograph showed diffuse calcification of the soft tissues overlying the left shoulder joint. Thoracic CT revealed extensive lobulated calcific densities surrounding the left glenohumeral and acromioclavicular joints consistent with tumoral calcinosis. Tumoral calcinosis is a rare condition manifested by periarticular calcified masses. Normally large joints are involved, such as hips, shoulders, and elbows. Tumoral calcinosis may be classified as primary, hereditary, and secondary to conditions such as collagen vascular disease. This patient’s tumoral calcinosis is secondary to progressive systemic sclerosis. A search in the Journal of Radiology Case Reports reveals only one case report on tumoral calcinosis and that is within a toddler. This case is unique as it is rare for tumoral calcinosis to co-exist with systemic sclerosis. A literature search reports the incidence of this association to be less than 1%. There have only been a few reports cases of tumoral calinosis affecting large joints in patients with systemic sclerosis.Our case is unique in that the calcinosis of our patient’s shoulder began as a joint effusion and progressed to tumoral calcinosis.