Presentation
Intense atraumatic right shoulder pain.
Patient Data
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.
Case Discussion
Calcific tendinitis of the shoulder is characterized by the deposition of calcium, in the rotator cuff, usually the supraspinatus. A complication is the migration of calcium deposits from tendons, into the subacromial-subdeltoid bursa or into the humeral greater tuberosity. Calcifications appear as hyperechoic foci with well-defined acoustic posterior shadowing but, due to the variable of calcific content, sometimes they can appear as hyperechoic clusters with faint or absent acoustic shadow. At ultrasound examination, the subacromial bursa appears thickened and filled with inhomogeneous hyperechoic fluid containing calcium and debris, in association with edematous changes in the surrounding fatty space.
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