An abdominal radiograph of an asymptomatic 72-year-old man shows a continuous vertical radiopaque line along the expected course of the iliac arteries. Peripheral pulses are intact and there are no ischemic symptoms. The most likely diagnosis is:

• A Atherosclerosis with significant luminal stenosis
• B Monckeberg medial calcific sclerosis ✓
• C Calciphylaxis of the cutaneous vasculature
• D Syphilitic aortitis with calcification

Explanation

Monckeberg medial calcific sclerosis is dystrophic calcification of the media of muscular arteries, typically in patients over 50, often with diabetes or chronic kidney disease. It produces the pipe stem or railroad track radiographic appearance but does not narrow the lumen and is clinically insignificant by itself. This absence of luminal compromise is exactly what separates it from atherosclerosis, making the symptomatic distractor untenable in this asymptomatic patient.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.