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The ultrasound images shows intrabursal migration of a calcification, most commonly calcium hydroxyapatite crystal, with acute bursitis characterized by parietal thickened and effusion within the subacromial–subdeltoid bursa. The subacromial–subdeltoid bursa are filled with hyperechoic fluid containing calcium and debris over an supraspinatus tendon with large calcific tendinitis associated with a insertional tear. There is also an effusion within the sheath of the long head of the biceps brachi tendon. Diffuse edema of the periarticular soft tissues is associated.