title: Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.
abstract: Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissue deposits of calcium phosphate near the large joints. It is more prevalent in patients with chronic kidney disease undergoing dialysis. A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. The patient had been suffering from chronic kidney disease for 10 years and had been undergoing peritoneal dialysis over the past 5 years. The patient's symptom was initially suspected to be of lumbar origin at the L5 level and a left L5 transforaminal epidural block was performed, but without success. Re-evaluation of the physical examination revealed severe tenderness over the left greater trochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-like lesions in the left buttock were observed. About 30 mL of fluid was aspirated from the cystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone 40 mg injected into the bursa under ultrasound guidance, which brought pain relief. Trochanteric bursitis was thought of as the cause of the symptoms. The patient was diagnosed with tumoral calcinosis based on the past medical history, simple plain radiographs, and hip magnetic resonance imaging (MRI). We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease. We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul Paik Hospital, Inje University, Seoul; Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University, Busan; Department of Rehabilitation Medicine, Haeundae Paik Hospital, Inj.
authors.forename: Dongjin
authors.initials: D
authors.lastname: Baek
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Kim
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jeon
authors.forename: Kihwa
authors.initials: K
authors.lastname: Lee
authors.forename: Jaewook
authors.initials: J
authors.lastname: Jung
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Joo
authors.forename: Jaehong
authors.initials: J
authors.lastname: Park
authors.forename: Yonghan
authors.initials: Y
authors.lastname: Kim
authors.forename: Young-gyun
authors.initials: YG
authors.lastname: Choi
mesh_terms: D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005269:Femur / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications*