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Abstract: FR-PO556

Striking Radiological Findings of Visceral Arteries Calcification in a Severe Calciphylaxis Patient

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yang, Canlin, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Liu, Yuqiu, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Xie, Xiaotong, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
  • Liu, Bi-Cheng, Zhong Da Hospital, Southeast University Medical School, Nanjing, JIangSu, China
  • Zhang, Xiaoliang, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
Introduction

Calciphylaxis is a rare complication of end stage renal disease characterized by calcification, fibrointimal hyperplasia, and thrombosis in the subcutaneous adipose tissue and dermis. Skin biopsy is the standard method for confirmed diagnose but it’s still controversial for creating new wounds. The imaging characteristics of calcification may help diagnose calciphylaxis. This article reports a severe visceral calciphylaxis patient confirmed by skin biopsy with striking calcification of the visceral vessels.

Case Description

A 45-year-old female with systemic lupus erythematosus have a 14-year medication history of oral glucocorticoids and 10-year maintenance hemodialysis. She had an erythema on toes and deteriorated into painful dry gangrene with infection 1 month before admission (Fig.1). Skin biopsy (Fig.2) confirmed the diagnosis of severe calciphylaxis. Interestingly, her imaging fingdings showed striking calcification of visceral blood vessels. Extensive calcification of arteries of pancreas, kidneys and intestinal canal can be seen in the computed tomography scan (Fig.3). Although she doesn’t have symptoms of visceral ischemia such as chronic abdominal pain or gastrointestinal bleeding, it may be a predictor of visceral calciphylaxis and she may show symptoms of visceral ischemia or bleeding one day. Computed tomography angiopraphy (CTA) of the lower limbs shows diffuse calcification the lower extremity arteries and soft tissues. Exactly, bone scintigraphy scan proved abnormal diffuse high uptake of subcutaneous soft tissue in crus that is in consistence with what shown in CTA (Fig.4). The efficacy of therapies based on sodium thiosulfate is still in follow-up.

Discussion

Characteristic histological features of calciphylaxis include medial arterial calcification and thrombosis in arterioles. This patient has typical clinical manifestations of severe calciphylaxis and striking imaging features of visceral vascular calcification. Biopsy in visceral arterioles is difficult, so that the combination of multiple imaging methods is valuable to early diagnosis of visceral calciphylaxis.