Title: Pre-Senescent Costochondral Calcification

Imaging Findings:
Figure Obliquely oriented linear, mottled calcific densities overlying the lower thoracic and upper abdomen on plain film images of this 26 year old female (arrows).

Clinical:
Asymptomatic, incidental finding.

Etiology:
Ossification of costal cartilage, not perichondral (1, 3). The more caudal (8 –10) costal cartilages are more readily visualized on routine chest and abdominal radiographs. Endocrine related hypercalcemic states do not appear to be strongly correlative (3). Vanstine et al showed genetic influences play a role in the absence of other disease states (2). Early development of such calcifications has been shown in adolescent patients with hyperthyroidism and is theorized to relate to abnormally advanced bone age, however, this finding is not pathognomonic (3). Females (76%) show marginal costal cartilage calcifications, males (70%) show central calcifications (4).

References:
1. King JB. Calcification of the costal cartilages. Brit J Radiol. 1939; 12:2-112.
2. Vanstine JH II, Vastine MF, Arango O. Genetic influence on osseous development with particular reference to deposition of calcium in costal cartilages. Am J Roentgenol. & Rad. Therapy, 1948; 59:213-221.
3. Senac MO Jr, Lee FA, Gilsanz V. Early costochondral calcification in adolescent hyperthyroidism. Radiology 1985; 156:375-377.
4. Navani S, et al. Determination of sex by costal cartilage calcification. Am J Roentgenol 1970; 1C8:771-774.