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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 58

Scapular mass in a young man with renal failure


Department of Nephrology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission29-Oct-2019
Date of Web Publication25-May-2021

Correspondence Address:
Harbir Singh Kohli
Department of Nephrology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1898_19

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How to cite this article:
Bharati J, Kohli HS. Scapular mass in a young man with renal failure. Indian J Med Res 2020;152, Suppl S1:58

How to cite this URL:
Bharati J, Kohli HS. Scapular mass in a young man with renal failure. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:58. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/58/316738

A 26 yr old male, on irregular haemodialysis for nine months presented to the department of Nephrology, Postgraduate Institute of Medical Education & Research, Chandigarh, India, in February 2019, with a three-month history of swellings around both the shoulder joints. These were gradually increasing in size but were painless without causing any movement restriction. Examination was notable for a multilobular mass over each of the shoulder joints and the scapulae, of non-tender, and firm consistency with no increased vascularity. Similar masses were observed over the bilateral heads of femur. Laboratory tests revealed serum calcium of 10 mg/dl (normal: 8.4-10.2 mg/dl), serum phosphate of 6.8 mg/dl (normal: 2.5-4.5 mg/dl), 25-hydroxy-vitamin D3 of 35 ng/ml (normal: 30-50 ng/ml) and intact parathormone of 880 pg/ml (normal: 15-65 pg/ml, up to nine times the upper limit is considered normal in end-stage renal failure). Radiography revealed dense chunks of calcification over the scapulae, glenohumeral joints and acetabulofemoral joints bilaterally [Figure 1]A, [Figure 1]B, [Figure 1]C. Ultrasonography of the neck revealed no parathyroid adenoma. Needle aspiration from the scapular masses showed calcific deposits on Von Kossa's stain. Diagnosis of secondary tumoral calcinosis due to secondary hyperparathyroidism was made. The patient was started on sevelamer bicarbonate (800 mg thrice a day), and dialysis (low calcium dialysate) thrice a week. At the last follow up (6 months), laboratory parameters normalized and the swellings subsided.
Figure 1: (A) Bilateral scapular masses (arrows). (B) Chunks of calcification over the right glenohumeral joint and scapula (arrows). (C) Chunks of calcification over the left glenohumeral joint and scapula (arrows).

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Conflicts of Interest: None.


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