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Heterotopic Ossification
Fathima Fijula P. Manzil, MDUmesh D. Oza, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Heterotopic ossification (HO): Extraskeletal osteogenesis
              • Myositis ossificans (MO): HO that develops within muscle
                • Myositis ossificans circumscripta (MOC)
                  • Adolescents and young adults < 30 years are mostly affected
                  • Myositis ossificans traumatica: Develop at site of muscle injury; occur in 9-14% of muscle contusions; more severe contusion → greater risk
                  • Myositis ossificans idiopathica
                • Myositis ossificans progressiva (MOP)/fibrodysplasia ossificans progressiva (FOP)/Münchmeyer disease
                  • Genetic predisposition
                  • May be associated with congenital anomalies
              • HO affecting tendons, fascia (fasciitis ossificans), subcutaneous fat
              • Ectopic ossification/ectopic calcification/dystrophic calcification 
                • Pathologic deposition of calcium salts or bone growth in soft tissues like lungs, eyes, arteries, or other organs
                • Can be symptom of hyperphosphatemia, ↑ vitamin D

          IMAGING

          • General Features

            • Nuclear Medicine Findings

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Ghanem MA et al: The added value of SPECT-CT in the detection of heterotopic ossification on bone scintigraphy. Skeletal Radiol. 49 (2): 291-8, 2020
                                          2. Gupta N et al: Fibrodysplasia ossificans progressiva - a rare genetic disorder and the role of technetium-99m methylene diphosphonate bone scan. Indian J Nucl Med. 34(3):209-12, 2019
                                          3. Rosteius T et al: Incidence and risk factors for heterotopic ossification following periprosthetic joint infection of the hip. Arch Orthop Trauma Surg. 139(9):1307-14, 2019
                                          4. Nauth A et al: Heterotopic ossification in orthopaedic trauma. J Orthop Trauma. 26(12):684-8, 2012
                                          5. Vavken P et al: Economic evaluation of NSAID and radiation to prevent heterotopic ossification after hip surgery. Arch Orthop Trauma Surg. 131(9):1309-15, 2011
                                          6. Crundwell N et al: Non-neoplastic conditions presenting as soft-tissue tumours. Clin Radiol. 62(1):18-27, 2007
                                          7. Shehab D et al: Heterotopic ossification. J Nucl Med. 43(3):346-53, 2002
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Heterotopic ossification (HO): Extraskeletal osteogenesis
                                                      • Myositis ossificans (MO): HO that develops within muscle
                                                        • Myositis ossificans circumscripta (MOC)
                                                          • Adolescents and young adults < 30 years are mostly affected
                                                          • Myositis ossificans traumatica: Develop at site of muscle injury; occur in 9-14% of muscle contusions; more severe contusion → greater risk
                                                          • Myositis ossificans idiopathica
                                                        • Myositis ossificans progressiva (MOP)/fibrodysplasia ossificans progressiva (FOP)/Münchmeyer disease
                                                          • Genetic predisposition
                                                          • May be associated with congenital anomalies
                                                      • HO affecting tendons, fascia (fasciitis ossificans), subcutaneous fat
                                                      • Ectopic ossification/ectopic calcification/dystrophic calcification 
                                                        • Pathologic deposition of calcium salts or bone growth in soft tissues like lungs, eyes, arteries, or other organs
                                                        • Can be symptom of hyperphosphatemia, ↑ vitamin D

                                                  IMAGING

                                                  • General Features

                                                    • Nuclear Medicine Findings

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Ghanem MA et al: The added value of SPECT-CT in the detection of heterotopic ossification on bone scintigraphy. Skeletal Radiol. 49 (2): 291-8, 2020
                                                                                  2. Gupta N et al: Fibrodysplasia ossificans progressiva - a rare genetic disorder and the role of technetium-99m methylene diphosphonate bone scan. Indian J Nucl Med. 34(3):209-12, 2019
                                                                                  3. Rosteius T et al: Incidence and risk factors for heterotopic ossification following periprosthetic joint infection of the hip. Arch Orthop Trauma Surg. 139(9):1307-14, 2019
                                                                                  4. Nauth A et al: Heterotopic ossification in orthopaedic trauma. J Orthop Trauma. 26(12):684-8, 2012
                                                                                  5. Vavken P et al: Economic evaluation of NSAID and radiation to prevent heterotopic ossification after hip surgery. Arch Orthop Trauma Surg. 131(9):1309-15, 2011
                                                                                  6. Crundwell N et al: Non-neoplastic conditions presenting as soft-tissue tumours. Clin Radiol. 62(1):18-27, 2007
                                                                                  7. Shehab D et al: Heterotopic ossification. J Nucl Med. 43(3):346-53, 2002