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JAMA Clinical Challenge | Clinician's Corner

Diffuse Calcification and a Draining Wound

Sandeep M. Patel, MD; Todd D. Miller, MD
JAMA. 2013;309(2):181-182. doi:10.1001/jama.2012.91090.
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A 46-year-old man receiving chronic hemodialysis for polycystic kidney disease is admitted to the hospital with new-onset dyspnea and altered sensorium. He is noted to have “milky” secretions draining from a spontaneous eruption on his left thigh (Figure 1A). His thigh is swollen; radiographs show bulky, extra-articular calcifications (Figure 1B). A 3.4 × 2.3-cm mass involving the posterior mitral leaflet associated with moderate regurgitation is found with transesophageal echocardiography.

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Figure 1. A, Lateral view of the left thigh at initial presentation showing spontaneously draining “milky” material. B, Radiograph of the pelvis and hips.
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Figure 2. Transesophageal 3-dimensional echocardiogram showing the mitral valve from the left atrial perspective. The heart is in diastole; a large multilobulated calcific mass can be seen attached to the posterior mitral leaflet (arrowhead).
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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