{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:16:17Z","timestamp":1790000177093,"version":"4.0.1"},"reference-count":38,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Monckeberg\u2019s medial sclerosis (MMS) is characterized by the calcification of the tunica media within the arterial wall, resulting in increased arterial stiffness. MMS typically affects the arteries of the lower limbs with elevated ankle\u2013brachial index (ABI) values and preserved peripheral perfusion. Commonly associated conditions are diabetes mellitus and chronic kidney disease (CKD). Case Presentation: We report two cases of MMS in middle-aged male individuals without these risk factors, both of whom had a history of long-standing professional athletic activity. In both cases, radiographs demonstrated characteristic \u201crailroad track\u201d medial calcifications, ABI values were elevated, and Doppler ultrasound showed calcifications but preserved triphasic flow without evidence of peripheral artery stenosis or occlusion. Conclusions: Given the absence of diabetes, CKD, or smoking history, we hypothesized that repeated strenuous exercise may have triggered the development of arterial calcifications in these two cases. Further research is needed to understand the underlying pathophysiological mechanisms and to determine the clinical and prognostic significance of medial arterial calcifications in athletes.<\/jats:p>","DOI":"10.3390\/diagnostics16183064","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Monckeberg\u2019s Medial Sclerosis in Athletes: Report of Two Cases and Possible Pathophysiological Mechanisms"],"prefix":"10.3390","volume":"16","author":[{"given":"Lorenzo","family":"Nigris","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Pattis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Gutmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Tr\u00f6binger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9458-4400","authenticated-orcid":false,"given":"Federica","family":"Ferro","sequence":"additional","affiliation":[{"name":"Department of Radiology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8239-3447","authenticated-orcid":false,"given":"Peter","family":"Marschang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bozen, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/wrr.13101","article-title":"M\u00f6nckeberg\u2019s medial calcific sclerosis in diabetic and non-diabetic foot infections","volume":"31","author":"Suludere","year":"2023","journal-title":"Wound Repair Regen."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1016\/j.jvs.2018.08.025","article-title":"LEA 14. 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