A case report comparing various radiological tests in the diagnosis of calcific uremic arteriolopathy.
BACKGROUND
Calcific uremic arteriolopathy (CUA) is a rare necrotizing skin condition characterized by calcification in arterioles, leading to ischemia and skin ulcerations. This disease affects 1% to 4% of patients with chronic kidney disease and has a reported mortality rate up to 80%. The diagnosis of CUA is based on clinical judgment suggested by the characteristic skin lesions. Although skin biopsy is the gold standard for establishing the diagnosis, it is performed infrequently because of poor healing and risk for secondary infections.


METHODS
In this case report, we compare the ability of various radiological tests to show arteriolar calcifications of patients with CUA. Our patient had biopsy-proven CUA manifesting as chronic nonhealing ulcers of the calves. She underwent soft-tissue x-ray of the affected extremities and high-resolution (0.5-mm slice) computed tomographic (CT) scanning with 3-dimensional image reconstruction. We also used a dedicated mammography machine to obtain images of the patient's calves. Images were compared based on the ability to show small-vessel calcification.


RESULTS
Plain soft-tissue x-ray showed mildly increased soft-tissue density and very few calcified vessels, whereas CT showed few calcified small- and medium-sized arterioles. Diffuse calcification of small arterioles in a mesh-like pattern was shown by means of the mammography technique.


CONCLUSIONS
Simple, safe, and inexpensive x-ray imaging using the mammography technique was superior to plain soft-tissue x-ray and 3-dimensional CT in showing the hallmark arteriolar calcifications of patients with CUA. Thus, we propose a possible role for this technique in diagnosing CUA.
Bleibel
Wissam
W
Department of Internal Medicine, Caritas Carney Hospital/Tufts University School of Medicine, Boston, MA, USA. wbleibel@bidmc.harvard.edu
Hazar
Bora
B
Herman
Richard
R
D000368:Aged; D001160:Arterioles / Q000000981:diagnostic imaging* / Q000473:pathology; D001706:Biopsy; D002115:Calciphylaxis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007866:Leg / Q000473:pathology; D008327:Mammography / Q000295:instrumentation; D012867:Skin / Q000098:blood supply; D012883:Skin Ulcer; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods