Weekly Case

Title : Case 630

Age / Sex : 46 / F


Chief complaint : Left knee pain for 1 week

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Kyung Ah Chun, 
Catholic Kwandong University, International St. Mary’s Hospital


 



Discussion


Answer:  


Calcific tendinitis (calcium hydroxyapatite deposition disease), biceps femoris tendon on fibular attachment


Findings:


Plain radiograph shows a well-defined, ovoid shaped, calcified mass over left fibular head.


MRI shows intratendinous calcified mass of low signal intensity at the fibular attachment of biceps femoris with diffuse biceps femoris muscle and lateral subcutaneous edema.


 


Differential Diagnosis:


Heterotopic ossification


Gout tophi


Soft tissue chondroma


 


Discussion:


Periarticular calcific tendinitis is an inflammatory condition associated with calcium hydroxyapatite crystal deposition disease processes. The shoulder is most commonly involved, but has also been seen in the hip, elbow and wrist joints. Hydroxyapatite crystals may deposit in the tendons, ligaments, joint capsule, soft tissues or bursae. Calcific deposits around the knee have been described involving the lateral collateral ligament, vastus lateralis and popliteus tendons.


The radiographic appearance of the crystal deposits reflects the duration of disease: initially, the crystals appear poorly defined and cloudlike, but as the disease progresses, they appear denser and homogeneous with a linear or circular configuration. MRI shows extensive edema in the muscle and adjacent bone marrow as high T2 signal intensity.


 


 


References:



  1. Chan W, Chase HE, Cahir JG, Walton NP. Calcific tendinitis of biceps femoris: an unusual site and cause for lateral knee pain. BMJ Case Rep 2016. doi:10.1136/bcr-2016-215745

  2. Anderson SE1Bosshard CSteinbach LSBallmer FT. MR imaging of calcification of the lateral collateral ligament of the knee: a rare abnormality and a cause of lateral knee pain.


AJR Am J Roentgenol. 2003;181(1):199-202.


 


 



Correct Answer
Total applicants 31 Correct answers 20
Name Institution
김기욱 국군수도병원, 전문의
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이혜란 전문의
장민영 국민건강보험공단 일산병원, 전문의
조은경 새움병원, 전문의
조영민 전문의
이연옥 선한목자병원, 전문의
이진영 전문의
강지희 서울대학교병원, 전문의
신재환 국군춘천병원, 전문의
김성진 365병원, 전문의
김주원 담양사랑병원, 전문의
최형인 군의관, 전문의
최현일 전공의
심주경 순천향대 부천병원, 전공의
정미란 전문의
성시윤 국군춘천병원, 전문의
김유진 전문의
장성원 중앙보훈병원, 전공의


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