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Siblings with multiple soft tissue calcifications
  1. S A Khan,
  2. M Zahid,
  3. N Asif,
  4. M Khalid
  1. Department of Orthopaedic Surgery, J N Medical College, Aligarh Muslim University, Aligarh (UP), India
  1. Dr Shah Alam Khan, Alam Manzil, Zohra Bagh, Dodpur, Aligarh (UP), 202 002, Indiashahalamkhan{at}mailcity.com

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Answers on p 543.

Two brothers aged 10 years and 18 years presented with multiple soft tissue calcareous swellings around the elbows, arms, knees, and forearms, which had been present for the last three years. Both were in good general health and there was no history of trauma. On examination, the younger boy had a calcified soft tissue swelling around the left knee joint with a sinus around the medial side of the knee. There was occasional discharge of white chalky material from the sinus. Movements at the knee were full and there was no neurovascular problem. The other brother had calcareous, firm, soft tissue swellings over the right lower thigh, left and right arms, and around both the elbow joints. Movements at the elbow and knee joints were normal and he had no discharging sinus. Their serum calcium, serum phosphorus, alkaline phosphatase, and urinary calcium were within normal limits. The erythrocyte sedimentation rate and the leukocyte count were normal. A test for lupus erythematosus was negative and there was no serum rheumatoid factor. Serum uric acid was normal. Plain radiographs of the elbows, knees, and thigh were taken; those of the knee in the younger brother and elbow and arm in the older brother are shown in figs1-3.

Questions

(1)
What are the radiological findings?
(2)
What is the diagnosis?
(3)
What is the pathogenesis and treatment of this condition?

Figure 1

Radiograph of the left knee joint (anteroposterior view) of the 10 year old brother.

Figure 2

Radiograph of the left elbow (lateral view) of the 18 year old brother including arm and forearm.      

Figure 3

Radiograph of the right elbow and arm (anteroposterior and lateral views) of the 18 year old brother.

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