Background. Calcifications of the costal cartilages occur, as a rule, not until the age of 30 years. The knowledge of the clinical significance of early and extensive calcifications is still incomplete. Materials and Methods. A search was made to find patients below the age of 30 years who showed distinct calcifications of their lower costal cartilages by viewing 360 random samples of intravenous pyelograms and abdominal plain films. The histories, and clinical and laboratory findings of these patients were analyzed. Results. Nineteen patients fulfilled the criteria of premature calcifications of costal cartilages (CCCs). The patients had in common that they were frequently referred to a hospital and were treated by several medical disciplines. Nevertheless many complaints of the patients remained unsolved. Premature CCCs were often associated with rare endocrine disorders, inborn errors of metabolism, and abnormal hematologic findings. Among the metabolic disorders there were 2 proven porphyrias and 7 patients with a suspected porphyria but with inconclusive laboratory findings. Conclusion. Premature CCCs are unlikely to be a normal variant in skeletal radiology. The findings in this small group of patients call for more intensive studies, especially in regard to the putative role of a porphyria. 1. Introduction The calcification of the costal cartilages follows gender-related patterns and is generally not evident radiographically until after the age of 30 years [1]. The forms and the onset of these calcifications were used to determine the gender and the age of unknown bodies in the forensic medicine [2–4]; however, the clinical significance of premature calcifications of the lower rib cartilages is not fully elucidated as yet. In case reports, there have been descriptions of an association of premature calcifications with hyperthyroidism [5, 6], corticosteroid medication [7], and rare congenital diseases such as adrenogenital syndrome [8, 9] or Keutel syndrome [10, 11], but some authors regard even extensive costal cartilage calcifications (CCC) as a normal finding or variant [12]. Some forty years ago, around 1968, a search was made for premature CCCs according to the criteria described below. Primary data have originated from the Kantonsspital Winterthur in Switzerland at the suggestion of the late Dr. Walter Bessler. We collected the clinical data of 14 patients with premature CCCs, but we felt at that time the data were somewhat inconclusive, and so we did not submit them for publication. However, we found the data interesting and kept them for
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