2. • Intra-abdominal calcification is common and the causes may
be classified into four broad groups based on morphology:
Concretions
• These are discrete precipitates in a vessel or organ. They are
sharp in outline but the density and shape vary but in some
cases, they may be virtually pathognomonic:
stones
renal stones
ureteric stones
bladder stones
gallstones
3. • Pancreatic calcifications
• Nodal calcification: most commonly from
treated lymphoma, tuberculosis or
histoplasmosis
• Phlebolith
• Appendicolith
• Calcified granuloma
• Failed renal transplant
• Encapsulating peritoneal sclerosis
4. Conduit calcification
• Calcification within the walls of any fluid-
filled hollow tube:
• Abdominal aorta
• Pancreatic duct
• Ductus deferens
• Large veins
5. Cystic calcification
• Calcification in the wall of a mass such as a cyst,
pseudocyst or aneurysm. Hallmark is a smooth curvilinear
rim of calcification:
• simple serous cysts
• aneurysms e.g. splenic or renal arteries
• echinococcal cysts
• organising haematoma
• 'porcelain' gallbladder
• calcified appendiceal mucocele
6. Solid mass calcification
• Diverse features which generally show extensive but variable
calcification:
• mesenteric nodes
• adrenal calcifications
• uterine fibroids
• primary tumours, e.g. ovarian dermoid
• metastases
• adrenal adenoma
• spleen, e.g. autosplenectomy in sickle cell disease
• renal tuberculosis with autonephrectomy
7. Urolithiasis
• Urolithiasis refers to the presence of calculi anywhere along
the course of the urinary tracts.
• Most patients tend to present between 30-60 years of age
• The lifetime incidence of renal stones is high, seen in as many
as 5% of women and 12% of males.
• By far the most common stone is calcium oxalate.
• Distribution of stones depends on the population and
associated metabolic abnormalities (e.g. struvite stones are
more frequently encountered in women, like urinary tract
infection as more common)
8. Pathology
• The composition of urinary tract stones varies widely
depending upon metabolic alterations, geography, and
presence of infection, and their size varies from gravel to
staghorn calculi.
• calcium oxalate +/- calcium phosphate: ~75%
• struvite (triple phosphate): 15%
• pure calcium phosphate: 5-7%
• uric acid: 5-8%
• cystine: 1%
• lithogenic medications: 1%
9. Radiographic features
These depend on the stone composition and vary according to modality. The much
greater sensitivity of CT to tissue attenuation means that some stones radiolucent on
plain radiography are nonetheless radiopaque on CT.
Plain radiograph
Calcium-containing stones are radiopaque:
• calcium oxalate +/- calcium phosphate
• struvite (triple phosphate) - usually opaque but variable
• pure calcium phosphate
Lucent stones include:
• uric acid
• cystine
• medication (indinavir is best known) stones
• pure matrix stones (although may have a radiodense rim or centre
12. Adrenal calcification
• Adrenal calcification is not a rare finding in healthy asymptomatic people and is
usually the result of previous haemorrhage or tuberculosis. Addison disease
patients only occasionally develop calcification.
• Pathology
• Aetiology
• Haemorrhage
• sepsis: Waterhouse-Friderichsen syndrome
• blunt abdominal trauma
• adrenal pseudocyst
• neonatal asphyxia
• coagulopathy
• infants: calcification seen soon after haemorrhage (as early as 1-2 weeks)
14. Radiographic features
• Adrenal calcification is best assessed on CT where it can be
differentiated from a calcified adrenal mass or lesion.
• In children, neuroblastoma has been reported as the commonest
calcifying adrenal mass. In adults, simple calcified cysts have been
reported as common adrenal masses, characteristically showing
peripheral curvilinear calcification.
• Post-haemorrhage calcification is usually seen after the initial adrenal
haematoma has resolved and, hence, is not usually seen with an
adrenal lesion. However, adrenal metastases such as from
bronchogenic tumours can present with haemorrhage, making the
diagnosis challenging.
16. Mature cystic ovarian teratoma
• Ovarian dermoid cyst and mature cystic
ovarian teratoma are terms often used
interchangeably to refer to the most common
ovarian neoplasm. These slow-growing
tumours contain elements from multiple germ
cell layers and are best assessed with
ultrasound.
18. • Phleboliths
• Phleboliths are literally "vein stones", and
represent calcification within venous
structures. They are particularly common in
the pelvis where they may mimic ureteric
calculi, and are also encountered frequently in
venous malformations. There is an association
with Maffucci syndrome.
19. Radiographic features
• Phleboliths appear as focal calcifications, often with
radiolucent centres (if present, a helpful sign to
distinguish them from urolithiasis). This appearance
is attributed to calcification peripherally within the
vessel and is frequently seen on abdominal
radiographs (66% of phleboliths). It can also be seen
on CT provided thin sections are obtained (at 5 mm
thick slices radiolucent centres will be inapparent in
99% of phleboliths
