Incidentally detected diffuse multiple rice-grain soft tissue calcifications on plain X-rays: hidden implications and further approach

Abstract Introduction Incidentally detected "rice-grain" calcifications on X-ray suggest underlying systemic conditions with significant implications. These elongated, linear calcifications, often found in soft tissue, are commonly associated with cysticercosis, a parasitic infection prevalent in regions with poor sanitation. While cysticercosis-related calcifications often remain asymptomatic, they warrant careful evaluation due to potential neurological complications, particularly neurocysticercosis, which can lead to seizures or neurological deficits. Early recognition and targeted follow-up are essential. Case details A 71-year-old Indian male with a history of traumatic urethral stricture and lower urinary tract symptoms presented for evaluation. A suprapubic catheter had been placed due to recent catheterisation complications. During imaging, diffuse rice-grain calcifications were incidentally observed on X-rays of the abdomen, pelvis, chest, limbs, and skull. The patient was asymptomatic for neurological or muscular symptoms. Laboratory findings, including renal function, calcium, vitamin D, and parathyroid hormone levels, were normal. CT and MRI of the brain revealed no signs of neurocysticercosis. A biopsy from the thigh confirmed a calcified cyst without evidence of Taenia solium. Consequently, a diagnosis of asymptomatic calcified cysticercosis was made. No antiparasitic treatment was initiated. The patient and his family were educated on preventive measures, and he was advised periodic follow-ups for symptom monitoring. Conclusion The incidental finding of rice-grain calcifications highlights the importance of a structured approach for differential diagnosis. In asymptomatic cysticercosis cases, lifestyle counselling and regular follow-ups are recommended to manage potential progression while preventing symptomatic neurocysticercosis. This case underscores the diagnostic and preventative measures necessary for individuals in endemic regions.