Unusual Metastatic Soft Tissue Calcification in a Hemodialysis Patient

摘要

Metastatic calcification is a serious complication of end-stage renal disease (ESRD) occurring throughout the body, including the interstitial tissue of the blood vessels,1 kidneys, lungs,2 and gastric mucosa. To our knowledge, calcification of the bilateral vas deferens in hemodialysis patients is extremely rare and has not been reported previously.A 67-year-old man on maintenance/ hemodialysis for 10 years complained of several days of intermittent abdominal distention. On physical examination, his blood pressure was 130/80 mm Hg, temperature 37.2degC, and pulse 102/min. Cardiac, pulmonary, and abdominal examinations were all unremarkable. His blood urea nitrogen was 121 mg/dL and creat-inine 9.8 mg/dL. A plain film of the abdomen (Fig. 1, arrowheads) showed two high-density, long, and symmetric sinuous lesions in the pelvic cavity, consistent with calcification of the vas deferens. Abdominal computed tomography (CT) scan (Fig. 2) confirmed that diagnosis and also revealed femoral artery calcification. The patient had been diagnosed with refractory secondary hyperparathyroidism one year prior which did not respond to treatment with IV vitamin D and phosphate binders. The serum phosphate level was 7.3 mg/dL and the calcium was 9.8 mg/dL. The serum intact parathyroid hormone had been over 900 pg/mL for a long time.