Title : Tumor-like calcification in patients undergoing hemodialysis
Abstract:
Tumor-like calcinosis is a condition where calcium phosphate crystals accumulate in the tissues around joints, forming large, calcified masses. Although the exact mechanisms are not fully understood, it is believed that an elevated calcium-phosphate product and severe hyperparathyroidism play key roles in its development. While surgery is commonly suggested for treatment, there remains ongoing debate regarding the best approach.
We describe a 63-year-old diabetic patient on long-term hemodialysis who presented with increasing pain in the left hip over the course of six months, along with limited mobility. A CT scan revealed a calcified mass in the posterior thigh, which was likely causing the sharp, electric-shock-like pain, as well as compression of the superficial femoral artery, leading to critical limb ischemia. Laboratory tests showed elevated calcium-phosphate levels and hyperparathyroidism, which supported the diagnosis of tumor-like calcinosis.
Due to the mass's close proximity to vascular and nerve structures, surgical removal was deemed unfeasible. The patient was instead managed with a conservative approach, including angioplasty to improve blood flow and alleviate symptoms. The rarity of this condition in hemodialysis patients, coupled with the calcified masses, made both the diagnosis and treatment particularly challenging.
This case highlights the diagnostic and treatment challenges of tumor-like calcinosis in chronic hemodialysis patients. Despite conservative management, the patient experienced persistent pain and functional impairment. Endovascular intervention, including double dilation with stenting, temporarily restored blood flow and relieved symptoms. However, this approach is not curative and carries a risk of rethrombosis. The complexity of managing calcinosis-related vascular complications in hemodialysis patients calls for further investigation into optimal treatment strategies for such rare cases.
