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Age / Sex : 41 / M
Age / Sex : 41/M
Chief complaint : Left hip pain for a month
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of
this case.
* Send Application Answers to In Sook Lee, MD ([email protected])
Courtesy : Lee Young-Hwan, Daegu Catholic university Medical Center
Diagnosis: Calcific tendinitis of rectus femoris tendon
Discussion
Findings:
Radiography of the pelvis shows no
apparent calcific density adjacent to the acetabulum.
Sonographic image of the left rectus
femoris tendon shows thickening of the tendon and tiny calcific spots without shadowing.
Sonographic image of the normal right rectus femoris tendon.
Fat-suppressed T2-weighted MR and
Gd-enhanced image shows soft tissue edema within and around the straight head
of the rectus femoris tendon and some marrow edema in the adjacent bone.
However, tiny calcifications were not visualized with abnormal intensities.
Differential
Diagnosis:
Calcific tendinitis
Avulsion injury.
Tendinopathy
Infectious or neoplastic disease.
Diagnosis:
Calcific tendinitis of rectus femoris
tendon.
Discussion:
Calcific
tendinitis around the hip is less common around the shoulder. In the hip
region, the involvement of the rectus femoris, gluteus maximus, gluteus minimus
and medius, vastus lateralis, piriformis, iliopsoas, adductor magnus, and
biceps femoris have been described.
Calcific
tendinitis is easy to diagnose based upon the clinical suspicion and the
typical
radiographic findings of calcification in the classic location. Radiographically,
amorphous or comet-tail appearance, suggesting their intratendinous location.
MR findings of
calcific tendinitis include inflammatory edematous changes not only in
the tendons and adjacent soft tissue but also in the bone marrow.
However, MR imaging is suboptimal for detecting soft tissue calcifications
compared with CT and radiography, MR imaging is superior in detecting the
marrow involvement. Therefore there might be some clinical confusion regarding
whether the lesion is an infection or neoplasm.
Sonographic
findings of calcific tendinitis include a thickening of the tendon, hyperechoic
calcific foci within tendinopathy, and increased vascularity on color Doppler
sonography. The calcific deposits mainly show a homogeneous ovoid hyperechoic foci
with or without posterior acoustic shadowing and the other features include an
inhomogeneous ovoid, mottled, and amorphous hyperechoic shadow. In addition to
the calcific deposits, a thickening of the tendon compared with the
contralateral side is a constant sonographic finding of calcific tendinitis around
the
hip.
References:
Hyun Seok Lee, M.D., Young Hwan Lee,
M.D., Nak Kwan Sung,. et al. Sonographic Findings of Calcific Tendinitis around
the Hip. J Korean Soc
Ultrasound Med 2005;24:139-144
Flemming DJ, Murphey MD, Shekitka
KM, Temple HT, Jelinek JJ, Kransdorf MJ. Osseous
involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am
J Roentgenol 2003;181: 965-972
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