Presentation
Left shoulder region bulge for the last six months. No trauma. Mild shoulder pain.
Patient Data



The clinically visible lump is a thin-walled anechoic cyst (28 x 27 x 17 mm) close to the left acromioclavicular joint. Non-localization of the supraspinatus or infraspinatus tendons favoring complete tear. Intact biceps long head, subscapularis and teres minor tendons. Fatty infiltration and volume loss involving the supraspinatus and infraspinatus muscles. Normal echopattern and volume of the teres minor muscle. Large acromian spur. Minimal fluid in the subdeltoid-subacromial bursa.
Case Discussion
An elderly lady presented with a lump over the left acromioclavicular joint region. The ultrasound shows the lesion being a cyst. This finding is like a tip of the iceberg. The underlying rotator cuff shows massive tear involving supraspinatus and infraspinatus tendons with secondary muscles changes. This is known as Geyser sign.