Mönckeberg Medial Arteriosclerosis in a Geriatric Patient with Chronic Kidney Disease and Poorly Controlled Diabetes Reporting for a Dental Recall Visit.

Mönckeberg medial arteriosclerosis is a condition characterized by the calcification of the tunica media layer of the blood vessels that are visible on plain radiography or sectional tomography. In dentistry, a properly acquired panoramic radiograph may show the condition incidentally. It is also known as medial arterial calcinosis and can be associated with diabetes mellitus or chronic kidney disease. This condition is different from the more common atherosclerosis where the tunica intima remains unaffected, and the diameter of the vessel lumen is preserved. Dental treatment can be performed when the patient is stable with medically controlled diabetes.

Calcified facial and maxillary arteries: Incidental radiographic findings indicative of Mönckeberg arteriosclerosis.

BACKGROUND AND OVERVIEW: Mönckeberg arteriosclerosis is a disease of unknown etiology characterized by dystrophic calcifications within the tunica media of small- and medium-sized arteries, leading to reduced arterial compliance. The authors report a case discovered incidentally on dental radiographs. CASE DESCRIPTION: A 78-year-old man with a complex medical history was seen for routine oral health care. Panoramic and bite-wing radiographs revealed a tortuous, linear calcification in the area of the left mandibular first molar anterior to the angle of the mandible and suggestive of a calcified facial artery. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Medical radiologists have used the presence of arterial calcifications to determine the severity and prognosis of such diseases as primary hyperparathyroidism, secondary hyperparathyroidism, coronary artery disease, and diabetes. The presence of Mönckeberg arteriosclerosis on dental radiographs can help oral health care professionals identify patients with undiagnosed systemic disease.

Mönckeberg's Disease of the Lower Limb.

Vascular calcification represents a group of several pathological states of differing aetiologies. Mönckeberg medial sclerosis is considered to be more widespread in the lower abdominal region and lower limbs. We present a 59-years-old male patient presented right foot gangrene. At physical exploration, femoral and popliteal pulses were presented and the ankle-brachial pressure index was 0.45, and the toe-brachial index was 0.33. The patient underwent distal angioplasty of anterior and posterior tibial arteries and due to inaccurate evolution a transmetatarsal amputation was required. Mönckeberg's medial sclerosis is diagnosed with an ABI>1.1, however, questions have been raised about the validity and the role of ABI in diagnosis of Mönckeberg's medial sclerosis. Colour-doppler vascular ultrasound allow a non-invasive technique widely available to detect vascular calcification and to differentiation between Mönckeberg's medial sclerosis and the atherosclerosis-related lesions.

A Review of the Role of Breast Arterial Calcification for Cardiovascular Risk Stratification in Women.

Cardiovascular disease continues to be the leading cause of death among women in the United States. One of the barriers to improving cardiovascular disease outcomes in women is the lack of reliable, effective screening modalities. Breast arterial calcification has emerged as a potential risk stratification tool. Localized deposition in the media of the artery, known as Mönckeberg medial calcific sclerosis, is notably different from the intimal atherosclerotic process commonly associated with coronary artery disease. Nonetheless, studies favor a correlation between breast arterial calcification and cardiovascular risk factors or coronary artery disease, defined as coronary artery calcification on computed tomography scan or both nonobstructive and obstructive lesions on angiography. Since a majority of women over the age of 40 undergo yearly breast cancer screening with mammography, measurement of breast arterial calcification may offer a personalized, noninvasive approach to risk-stratify women for cardiovascular disease at no additional cost or radiation. Mammography has the potential to alter the course of the leading cause of death in women, heart disease, through the evaluation of breast arterial calcification and identification of opportunities for prevention. Current evidence supports the universal reporting of breast arterial calcifications and personalized patient-provider discussions to more aggressively treat cardiac risk factors through targeted medical therapies or healthy lifestyle changes.

Imaging Features of Soft-Tissue Calcifications and Related Diseases: A Systematic Approach.

Soft-tissue calcification refers to a broad category of lesions. Calcifications are frequently identified by radiologists in daily practice. Using a simple algorithm based on the distribution pattern of the lesions and detailed clinical information, these calcified lesions can be systematically evaluated. The distribution pattern of the calcific deposits enables initial division into calcinosis circumscripta and calcinosis universalis. Using laboratory test results (serum calcium and phosphate levels) and clinical history, calcinosis circumscripta can be further categorized into four subtypes: dystrophic, iatrogenic, metastatic, and idiopathic calcification. This pictorial essay presents a systematic approach to the imaging features of soft-tissue calcifications and related diseases.

Mönckeberg medial calcinosis of the infraorbital arteries: a first case report.

Mönckeberg medial calcinosis describes calcifications affecting only the tunica media of medium-sized arteries. The entity is strongly associated with chronic kidney disease and diabetes mellitus. Radiographically, medial calcinosis presents as areas of linear calcifications in soft tissue; the linear calcifications are referred to as "tram tracks," "pipe stem," "rail tracking," or "tram line" when the affected vessel is viewed longitudinally. In oral and maxillofacial radiology, it is generally an incidental finding of the facial artery. In this article, we review the literature of Mönckeberg medial calcinosis and its clinical significance related to systemic diseases; we also present a case of Mönckeberg medial calcinosis of the head and neck that affects the facial arteries, internal carotid arteries, and infraorbital arteries. We believe this is the first presentation in the literature of Mönckeberg medial calcinosis visualized in the infraorbital arteries.

Monckeberg Arteriosclerosis: A Telltale Sign.

Monckeberg arteriosclerosis is often an incidental finding recognized at plain radiography. It differs from the more common atherosclerosis in that the tunica intima remains unaffected; hence, the vessel lumen is preserved. Monckeberg arteriosclerosis is most commonly seen in patients with diabetes and patients with end-stage renal disease. In this short communication, the author presents a rare case of Monckeberg arteriosclerosis affecting the facial vasculature.

Detection of Monckeberg Medial Sclerosis on Conventional Dental Imaging.

Vascular calcification occurs with aging, and several risk factors including diabetes, hyperlipidemia, and disorders of calcium metabolism have been identified. M6nckeberg medial sclerosis (MMS) is the most common variant of medial calcification. M6nckeberg sclerosis can lead to significant adverse cardiovascular outcomes such as arterial stiffness, increased pulse and left ventricular hypertrophy. Here we report two cases of MMS involving facial vasculature, diagnosed incidentally on radiographs during their routine dental evaluation. They appear as convoluted "railroad tracks" patterns of the facial artery calcification. We believe that a better understanding and identification of these calcifications can lead to appropriate patient follow-up with medical providers and interventions to reduce morbidity and mortality by potentially predicting possible cardiovascular events.

(18)F-sodium fluoride PET/CT for the in vivo visualization of Mönckeberg's sclerosis in a diabetic patient.

Diabetes is a major frequent cause of atherosclerosis vascular disease. Arterial calcification in diabetic patients is responsible for peripheral vascular involvement. Molecular imaging using (18)F-sodium fluoride ((18)F-NaF) positron emission tomography (PET)/computed tomography (CT) has been recently proposed as a marker to study the in vivo mineralization process in the atheroma plaque. A 69-year-old man with a history of type 2 diabetes and no clinical evidence of peripheral arterial disease underwent an (18)F-NaF PET/CT scan. A linear, well-defined (18)F-NaF uptake was detected along the femoral arteries. In addition, the CT component of the PET/CT identified an unsuspected "tram-track" calcification in his femoral arteries, suggestive of medial calcification (Mönckeberg's sclerosis). In other vascular territories, focal (18)F-NaF uptake was also detected in carotid and aorta atheroma plaques. Molecular imaging with (18)F-NaF PET/CT might provide new functional information about the in vivo vascular calcification process in diabetic patients.

US assessment of medial arterial calcification: a sensitive marker of diabetes-related microvascular and macrovascular complications.

PURPOSE: To examine the sensitivity of ultrasonography (US) compared with conventional radiography in detection of lower limb (thigh) medial arterial calcification (MAC) in type 2 diabetic patients and evaluate its association with diabetes-related complications. MATERIALS AND METHODS: The study was approved by the local research ethics committee, and informed written consent was obtained. US was performed in 289 patients with type 2 diabetes mellitus, and MAC severity was assigned a score from 0 to 8. Among the patients, 263 underwent radiographic examinations. All subjects underwent clinical evaluation to detect the presence of diabetes-related complications. RESULTS: US helped detect MAC in more subjects compared with radiography (65.8% vs 12.2%). US helped detect MAC from mild (scores 1-4) to severe (scores 5-8) degrees, while mild degree of MAC was poorly demonstrated with radiography. The incidence of nephropathy, retinopathy, sensory neuropathy, and macrovascular complications increased with the severity of MAC (based on US scoring). With univariate analysis, the presence of MAC was associated with nephropathy (P<.001), retinopathy (P<.001), sensory neuropathy (P=.004), and macrovascular complications (P<.001). After adjustment for potential confounders, the presence of severe MAC was associated with nephropathy, retinopathy, and macrovascular complications, with the odds ratios of 3.4 (95% confidence interval [CI]: 1.53, 7.43; P=.003), 2.6 (95% CI: 1.22, 5.32; P=.013), and 3.8 (95% CI: 1.37, 10.6; P=.01), respectively. CONCLUSION: In type 2 diabetic Chinese patients, US was more sensitive than conventional radiography in the detection of MAC, particularly when the MAC was mild. The presence of severe MAC was associated with diabetic nephropathy, retinopathy, and macrovascular complications. US detection of MAC was a potential early marker to identify diabetes-related complications.

Monckeberg's sclerosis in a patient with systemic sclerosis.

Monckeberg's sclerosis (MS) is one of the non-inflammatory vascular diseases characterized by calcification of the media of small and medium-sized muscular arteries, but is distinct from atherosclerosis. We present a case of MS that was incidentally detected by plain X-ray in a patient with systemic sclerosis. We took CT angiographs of the patient's lower extremities for the differential diagnosis of vascular calcification, which was confirmed. To determine if systemic sclerosis is a risk factor for MS, we reviewed plain X-rays from 43 well-documented systemic sclerosis patients, but we did not detect any cases of MS. We therefore conclude that systemic sclerosis may not be a risk factor for MS.

Medial artery calcification as an indicator of diabetic peripheral vascular disease.

BACKGROUND: Mönckeberg sclerosis or medial artery calcification (MAC) is a well-known phenomenon associated with diabetic and other arterial disease. However, its consequence within the foot, and specifically the first dorsal metatarsal artery, has not previously been studied. MATERIALS AND METHODS: Nearly 1,000 foot x-rays were studied over a 9-month period in a busy hospital to identify the prevalence of first dorsal metatarsal artery calcification. The electronic medical notes for all the patients were reviewed to confirm which patients were known to be diabetic. The patients with positive findings were then identified and their HbA1c, creatinine, and previous foot interventions recorded. RESULTS: Of the population studied, 1.4% had medial artery calcification of the 1st dorsal metatarsal artery: 93% were known diabetics and 100% had impaired glucose tolerance (a glucose plasma concentration of greater than 7.8 mmol/l 2-hours post-glucose loading). Seventy-nine percent had required previous podiatric care for foot ulceration and 64% had required surgical intervention for their diabetic feet. MAC has a high positive predictive value (92.9% (95% CI 69.2 to 98.7)) for diabetes, with a good specificity (99.9% (95%CI 99.4 to 100)) and low false positive rate (0.1% (05%CI 0.0 to 0.6)). CONCLUSION: Medial artery calcification in the first dorsal metatarsal artery is characteristic of impaired glucose metabolism, and if seen on routine x-ray should be an indication for screening of the patient. It should also be considered as a foot-at-risk sign in the established diabetic due to the high incidence of foot ulceration and need for surgical intervention in this group.