CASE 17191 Published on 02.03.2021

Monckeberg's Medial Calcific Sclerosis



Case Type

Clinical Cases


Sabahattin Yüzkan, MD,

Department of Radiology, Ege University School of Medicine, Izmir, Turkey


70 years, male

Area of Interest Cardiovascular system, Vascular ; Imaging Technique Conventional radiography
Clinical History

A 70-year-old male patient presented to our hospital with bilateral chronic knee and heel pain. He states that the pain increases with mechanical movements. In addition, sometimes numbness and tingling in the legs are described. On physical examination, there was no swelling or warmth of joints.

Imaging Findings

In this case, roentgenograms of knees and ankles were performed. On the x-ray images, tortuous diffuse calcifications were observed incidentally on both sides of the distal superficial femoral artery, popliteal artery and anterior tibial artery. There was a typical “rail-tracking” and “pipestem” appearance that defined for Monckeberg's medial calcific sclerosis (Figure 1, 2, and 3).


Mönckeberg’s medial calcific sclerosis is a dystrophic calcification of tunica media layer of the extremity or visceral organ arteries [1]. The aetiology is unknown [1]. Mönckeberg's sclerosis is a degenerative disease [2].  It is a disease that reduces arterial compliance but does not obstruct the vessel lumen. Therefore it does not cause ischemic symptoms in the extremity or visceral organs[1,2,3]. It is seen commonly in older, diabetic and dialysis-dependent patients [1,2]. It is usually an incidental finding during extremity radiographic examination. In our case laboratory studies showed normal complete blood count, biochemical laboratory values, erythrocyte sedimentation rate, and C-reactive protein values. Also, there was no clinical history of any chronic disease. It was observed incidentally. The calcification of Mönckeberg’s medial calcific sclerosis is typically diffuse and circumferential along the arteries and readily visible on roentgenograms. Typically there is a  “rail-tracking” and “pipestem” appearance that was defined for Monckeberg's medial calcific sclerosis(2). Additionally, some studies are reported massive areas of soft tissue calcifications in the pharynx or larynx (2). In conclusion, to achieve an early and accurate diagnosis, it is necessary to know the characteristic radiographic findings of Mönckeberg’s medial calcific sclerosis. Treatment is usually conservative. For example in our patient, no signs of inflammatory arthritis or septic arthritis were found and the patient was treated with analgesic-antiinflammatory drugs and pregabalin for his complaints.

Written informed patient consent for publication has been obtained

Differential Diagnosis List
Monckeberg's Medial Calcific Sclerosis
Metastatic calcification
Final Diagnosis
Monckeberg's Medial Calcific Sclerosis
Case information
DOI: 10.35100/eurorad/case.17191
ISSN: 1563-4086