Age / Sex : 50 / F

Chief complaint : Right shoulder pain for 3yrs


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 : 박세경(Sekyoung Park), 고신대학교 복음병원 (Kosin university Gospel Hospital)

Rheumatoid arthritis

Discussion

Findings
Radiograph:
bone erosion and subchondral cyst at humeral head.
MR:
Subchondral cyst and erosion at right humeral head.
Thick synovial enhancement at right shoulder joint
Subacormial and subdeltoid bursitis with internal T2 low SI bodies.

References
Choi JA, Koh SH, Hong SH, Koh YH, Choi JY, Kang HS. Rheumatoid arthritis and tuberculous arthritis: differentiating MRI features. AJR Am J Roentgenol. 2009 Nov;193(5):1347-53.
Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. Radiographics. 2010 Jan;30(1):143-63; discussion 163-5. 
Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics. 2005 Mar-Apr;25(2):381-98.
Min, Kyoung-Dae, et al. “Multiple Rice Bodies in Subacromial Space - A Case Report -.” The Journal of the Korean Shoulder and Elbow Society, vol. 10, no. 2, Korean Shoulder and Elbow Society, 15 Dec. 2007, pp. 232–235.
Hye Jung Choo, Sun Joo Lee, Kil Ho Cho, et al. Synovial Lesions with Low Signal Intensities on T2-Weighted MR ImageJournal of Korean Soc. Magn. Reson. Med. 15:1-10(2011).