1. Neonatal – due to high placental oestrogens.

2. Pubertal – due to an excess of oestradiol over testosterone.

3. Senile – due to falling androgen and rising oestrogen levels with age.

1. Oestrogens or drugs with oestrogen-like activity – treatment of carcinoma of the prostate; digitalis.

2. Enhanced oestrogen synthesis – gonadotrophins, phenytoin.

3. Anti-androgens – spironolactone, metronidazole, alkylating agents, ketoconazole.

4. Idiopathic – phenothiazines, tricyclic antidepressants, ACE inhibitors, omeprazole.

1. Atheroma/aneurysm.

2. Diabetes.

3. Hyperparathyroidism* – more common in secondary than primary.

1. Leprosy.

2. Neurofibromatosis*.

1. Tendonitis – supraspinatus.

2. Ankylosing spondylitis*.

3. Fluorosis.

4. Diabetes.

5. Alkaptonuria.

1. Cysticerci – oval with lucent centre. Often arranged in the direction of muscle fibres.

2. Guinea worm – irregular coiled appearance.

3. Loa loa – thread-like coil. Particularly in the web spaces of the hand.

4. Armillifer – ‘comma’-shaped. Only in trunk muscles.

Rahalkar, M. D., Shetty, D. D., Kelkar, A. B., et al. The many faces of cysticercosis. Clin Radiol. 2000; 55:668–674.

1. Scleroderma*.

2. Dermatomyositis.

3. Polymyositis.

4. Mixed connective tissue disease.

5. Bursitis – can be dense and lobulated.

6. Ehlers–Danlos syndrome.

1. Gout* – calcified tophi. Punched-out erosions.

2. Calcium hydroxyapatite deposition disease.

3. Calcium pyrophosphate deposition disease*.

4. Tumoral calcinosis – age 20–30 years. Adjacent to a major joint. Firm, non-tender, movable mass which is well-defined, lobulated and calcified on X-ray. Osseous involvement is rare. Usually hyperphosphataemia. ± Calcium fluid level.

5. Hyperparathyroidism* – more common in secondary hyperparathyroidism. Vascular calcification is common.

6. Treatment with 1α-OHD₃ – particularly shoulder, hip and metacarpophalangeal joints.

7. Sarcoidosis* – rare. Hypercalcaemia. Affects hands and feet.

8. Hypervitaminosis D.

1. Myositis ossificans – outer part is more densely calcified than the centre.

2. Haematoma.

3. Calcifying myonecrosis.

4. Burns.

1. Benign

2. Malignant

Olsen, K. M., Chew, F. S. Tumoural calcinosis: pearls, polemics and alternative possibilities. Radiographics. 2006; 26:871–885.

1. Myositis ossificans – typically thigh, 6 weeks post-trauma; peripheral pattern, maturing to form well-defined mass with cortex and trabeculae.

2. Surgery – heterotopic ossification typically following hip replacement.

3. Burns.

4. Neurogenic – paraplegia and postcomatose states.

1. Synovial sarcoma.

2. Parosteal osteosarcoma.

3. Liposarcoma.

Fibrodysplasia ossificans progressiva – rare AD condition; progressive disabling heterotopic ossification.

Gartner, L., Pearce, C. J., Saifuddin, A. The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol. 2009; 38(6):549–558.

Wu, J. S., Hochman, M. G. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009; 253(2):297–316.