Caseous Peripheral Medial Arterial Calcification With Inflammation and Luminal Occlusion
Year: 2026
Type: article
Study design: Case Report
Abstract: BACKGROUND: Caseous calcification is a rare form of calcification characterized by liquefactive degeneration into amorphous, cheese-like material. Although well recognized in mitral annular calcification, it has not been reported in peripheral arteries. CASE SUMMARY: A 51-year-old man with end-stage renal disease on peritoneal dialysis developed chronic limb-threatening ischemia requiring below-the-knee amputation despite revascularization. Radiography, micro-computed tomography, and histology of the anterior tibial artery demonstrated focal caseous calcification within extensive medial calcification. Unlike sheet-like calcification with minimal inflammation, caseous lesions were associated with numerous multinucleated giant cells, macrophages, and T lymphocytes, as well as thrombus formation, severe luminal narrowing, and focal chronic total occlusion. DISCUSSION: This case provides the first histopathological evidence of peripheral arterial caseous calcification associated with severe inflammatory response and luminal occlusion. TAKE-HOME MESSAGE: Caseous calcification may represent a distinct inflammatory phenotype of medial arterial calcification that contributes to luminal narrowing and thrombosis in the absence of atherosclerosis.
Source: JACC Case Reports
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $850
Funders: Amgen, Sanofi, Edwards Lifesciences, Mayo Foundation for Medical Education and Research, Asahi Group Holdings, Boston Scientific Corporation, Rush University, Olympus, Cook Medical, BD Biosciences, Ionis Pharmaceuticals, Society for Music Theory, UPMC Enterprises, ReCor Medical, Dexcom, Cerus Corporation, Medtronic, Children's National Hospital, Canon Medical Systems USA, Fondation Leducq, Biotronik, Terumo, Biosensors International Group, OrbusNeich, MicroPort, National Institutes of Health, Abbott Vascular, Cancer Science Institute of Singapore, National University of Singapore, National Institute of Diabetes and Digestive and Kidney Diseases, Envision
OpenAlex ID: W7213466902