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Journal of Postgraduate Medicine, Vol. 52, No. 4, October-December, 2006, pp. 306-307 Images In Radiology Misurata stones El Fortia Mohamed Department of Radiology, Misurata Teaching Hospital, P.O. Box 1785 Date of Submission: 13-May-2005 Code Number: jp06104 In the region of Misurata city, Libya, many individuals aged over 50 years demonstrate the presence of multiple calcified structures on plain abdominal radiographs [Figure - 1]. These structures vary between 1 and 7 cm in diameter and are likely to be confused with other abdominal pathologies. These calcifications appear as round or oval balls on 3D CT scan reformat [Figure - 2]a-c. CT scan discloses high density [Min / Max: 144 / 628 "Mean: 250.9 / 111.5" HU]. Only the mesentery and / or omentum are affected. However, the rest of the abdominal organs are devoid of any calcifications. All the stones that were found incidentally in most of patients, who underwent abdominal surgery for other reasons, were removed. The pathology report revealed "fibrous and calcified encapsulation of necrotic debris". Misurata stones are clinically insignificant. Therefore, no treatment is advised except surgical excision for the larger ones to avoid pressure complications upon the neighboring abdominal structures. Discussion Calcifications are often seen on plain abdominal radiographs. Interpretation of these calcifications can be approached by categorizing them as being discretely confined to a certain organ or diffusely located throughout the abdomen.[1],[2] Calcifications localized to an organ or anatomical structure can be recognized by their site and distribution. For example, pancreatic calcifications are distributed linearly from the epigastrium across to the splenic area. The pattern of calcification is often related to the underlying pathological process.[1],[2] Tuberculosis can closely mimic peritoneal carcinomatosis radiographically and clinical information is important in its differentiation. Lymphadenopathy, disproportionately involving the mesentery, is suggestive of tuberculosis. Abdominal involvement by tuberculosis may be seen in up to 38% of patients with pulmonary tuberculosis.[3] Calcifications secondary to tuberculosis or histoplasmosis usually appear as multiple, small and scattered rounded densities. In contrast to the curvilinear calcifications occurring within the wall of a cyst, abscess organized hematoma or hollow viscus, such as the gall bladder. Phleboliths are typically small and are commonly located in the pelvic region. Calcifications scattered throughout the peritoneum should be considered when they are diffuse and not confined to any single organ. Causes of such diffuse calcifications include peritoneal metastases, tuberculous peritonitis, calcified lynphadenopathies and dessiminated echinococcosis. Metastases to peritoneal surfaces of the diaphragm, liver and spleen are common and are seen as low attenuation masses that cause a concave or scalloped defect on the adjacent hepatic and splenic parenchyma.[4] In our cases, the calcifications or stones were found incompatible with these causes because they were limited to the Misuratean population of a specific age group and were localized in one part of the human body (abdominal cavity) and they were not situated along the site of lymph nodes′ distribution. These incidental X-ray findings are not seen in the younger generation and remain, a phenomenon of so far an unknown etiology. References
Copyright 2006 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp06104f1.jpg] [jp06104f2c.jpg] [jp06104f2a.jpg] [jp06104f2b.jpg] [jp06104f2.jpg] |
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