A routine radiograph of the lower limb in a 70-year-old asymptomatic man shows ring-like calcifications outlining the femoral and tibial arteries. Pulses are well felt and ankle-brachial index is normal. The most likely diagnosis is:
- A Occlusive peripheral atherosclerotic disease
- B Monckeberg medial calcific sclerosis ✓
- C Calciphylaxis due to secondary hyperparathyroidism
- D Polyarteritis nodosa with healed aneurysms
Explanation
Monckeberg medial calcific sclerosis is calcification of the media of muscular arteries, typically in persons above 50 years, especially those with diabetes. It produces the characteristic rail-track or ring-like radiographic pattern but does not obstruct the lumen and is usually clinically insignificant, which fits the normal pulses and ankle-brachial index here. Occlusive atherosclerosis would reduce the ABI, calciphylaxis involves painful skin necrosis with small vessel calcification, and healed polyarteritis nodosa does not produce this uniform medial calcification pattern.
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.