Age / Sex : 35 / F

Chief complaint : palpable lesion in left proximal thigh

What is your impression?

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

Courtesy : Seok Han, Inje University Haeundae Paik Hospital

Discussion

Answer:

Calcific tendinitis of gluteus maximus tendon

Findings:

X-ray: a relatively homogeneous and well-defined calcification deposition in posterolateral aspect of left upper thigh level

MRI: heterogenous signal intensity lesion at gluteal tuberosity of left femur with contrast enhancement in adjacent soft tissue

Differential Diagnosis:

myositis ossificans, periosteal chondral tumor, osteogenic or synovial sarcoma

Discussion:

Calcific tendinitis is a common disorder of the supraspinatus tendon, but less frequently, it may also involve the tendons of the gluteus maximus. Anatomically, there are two components of the tendon of the gluteus maximus muscle. The more proximal and major portion of the muscle fibers ends in a tendinous insertion on the iliotibial band of the tensor fascia lata dorsal and distal to the greater trochanter on the dorsal aspect of the femur. The gluteal tuberosity is a short ridge of bone representing the proximal and lateral extension of the linea aspera.

Clinically, most patients with acute gluteus maximus tendinitis present with severe pain in the hip and upper thigh posteriorly. On physical examination focal tenderness is elicited over the gluteal tubercle.

References:

Skeletal Radiol. 1983;9(3):198-200.

Clin Radiol. 1998 Apr;53(4):296-301.