Soft tissue calcifications

Phleboliths
-Rhinoliths and Antroliths
-Metastatic Calcification
--

Supervisor : Dr. Mustafa AlKhadr

Phleboliths
Disease Mechanism.
Clinical Features.
Imaging Features.
Differential Diagnosis.

Disease
Mechanism
Intravascular thrombi arise fromvenous Stagnation
Calcified thrombi in veins, venulae, or sinusoidal vessels of hemangiomas
. (CAVERNOUS type)
sometimes become organized,mineralized
Mineralization begins in the core of
thrombus
consist of: crystals of calciumcarbonate-fluorohydroxyapatite

Clinical Features
In the head and neck, phleboliths nearly.always signal the presence of a hemangioma
In an adults, it may be the sole residual of a . childhood hemangioma
involved soft tissue may be:
swollenthrobbing
discolored
by presence of veins or soft tissue
)
(hemangioma

Hemangio
ma

Hemangiomas often fluctuate in sizeassociated with changes in body position or during a Valsalva Maneuver
involved tissue may be blanch orchange in color if lesion is vascular by
.applying pressure
Auscultation may reveal a bruit in cases of cavernous type

Location
Most commonly are found inHemangiomas
Periphery and Shape
shape is round or oval, up to 6 mm indiameter
with smooth peripheryphlebolith may resemble a straight orslightly curved sausage

Internal structure
homogeneously radiopaquecommonly it has appearance of laminations. (bulls-eye or targetoid appearance)
radiolucent flow voids: represent theremaining patent portions of the vessel

Phleboliths are soft tissue

dystrophic calcifications
found in veins. They are
usually associated with
.hemangiomas

bull s -eye or
target

Sialoliths
Submandibularsialoliths
usually occur
singly
If more thanone is present
theyre
oriented in a
. single line

Phleboliths usually
are multiple, have
more random,
clustered
distribution

Identification of a possiblevascular lesion , such as a

.hemangioma
Critical if surgical procedures are contemplated

Rhinoliths and Antroliths

Disease mechanism .
Clinical Features
.
Imaging Features
.
Differential Diagnosis
Management
.

Rhinoliths Calcareous concretions occur in the

nose
Antroliths Calcareous concretions occur in the
antrum of the maxillary sinus

Arise from the deposition of nasal,lacrimal, and inflammatory mineral salts

(Calcium phosphate, calcium carbonate,
and magnesium, by accretion around a
nidus)
- Rarely formed in frontal or ethmoid
sinus

Periphery and shape: stones with various shapes

and sizes, depending on nidus nature
Internal structure: homogeneous or heterogeneous
radiopacities and sometimes may have laminations
.The density exceeds the surrounding bone
*

Lateral occlusal
film shows a
rhinolith above
the floor of nose

Posteroanterior
skull film shows a
rhinolith within the
nasal fossa

Axial and coronal CBCT image reveals

the presence of antrolith

Rhinol
ith
The nidus is usually anexogenous foreign body
(e.g. Coins, beads,
seeds and fruit pits)
Adult drug smugglersroute of entry is usuallyanterior
some may enter thechoana posteriorly
during sneezing,
.coughing, or emesis

Antr
olith
The nidus is usually
-

endogenous (e.g. Root tip,

bone fragment, blood clot,
ectopic tooth)
- dystrophic calcification
within chronically inflamed
sinus in long standing
sinusitis
- small scattered and faint
calcifications in thickened
mucosal lining
- noninvasive aspergillosis
mycetoma may develop in
antrum
- Mycetoma manifest as a
muddy, necrotic fungus ball or
transform into a hard mycolith

Patient may be asymptomatic for extendedperiods

expanding mass may impinge on the mucosa, producing pain, congestion, and ulceration
nasal obstruction, unilateral purulent orblood-stained rhinorrhea, sinusitis, headache,
epistaxis, anosmia, fetor and fever

Differential
Diagnosis

Osteoma- 1
odontoma- 2
calcified polyp- 3
surgical ciliated- 4
cyst

Pa t i e n t s h o u l d b e r e f e r r e d to an
(otorhinolaryngologist) for
endonasal or sinus
endoscopic surgical
.r e m o v a l o f t h e m a s s
Lithotripsy to debulklarge rhinoliths

Metastatic Calcifications
Caused by conditions involving-elevated serum calcium and
.phosphate levels : e.g
Hyperparathyroidism
*
Hypercalcemia of
*
malignancy
Extremely rareSymmetrical and bilateral-

Done by: Dana Qatamin

With all due respect