Calcification — Dystrophic vs Metastatic

A 58-year-old man from Delhi presents with a 3-month history of progressive dyspnea and orthopnea. On examination, he has a blood pressure of 160/95 mmHg, elevated JVP, and bilateral ankle edema. Echocardiography reveals severe left ventricular dysfunction (EF 25%) with evidence of calcification in the mitral valve leaflets. Serum calcium is 8.2 mg/dL (normal), serum phosphate is 3.8 mg/dL (normal), and alkaline phosphatase is 65 U/L (normal). A chest X-ray shows cardiomegaly and pulmonary edema. Histopathology of a valve biopsy shows calcium deposits within areas of fibrosis and necrosis. Which type of calcification is most likely responsible for the valve pathology in this patient?

A 52-year-old woman from Mumbai with a 10-year history of chronic kidney disease (stage 4, eGFR 28 mL/min/1.73m²) presents with bone pain and muscle weakness. Laboratory investigations show: serum calcium 10.8 mg/dL (normal 8.5–10.5), serum phosphate 5.2 mg/dL (normal 2.5–4.5), alkaline phosphatase 120 U/L (normal 30–120), and PTH 380 pg/mL (normal 15–65). Imaging reveals extensive calcification in the coronary arteries, aorta, and soft tissues around the joints. Histopathology of a vascular biopsy shows calcium deposition in the media of blood vessels and surrounding connective tissue, which appears histologically normal. What is the primary mechanism driving calcification in this patient?

In dystrophic calcification, calcium deposition occurs in tissues with normal serum calcium and phosphate levels. Which of the following is the PRIMARY pathological mechanism underlying this process?

A 58-year-old man with primary hyperparathyroidism (serum calcium 11.5 mg/dL, normal phosphate) develops calcification in his normal lung parenchyma and kidney tubules. This type of calcification is classified as: