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Tumoral calcinosis - subdeltoid bursa

Case contributed by Vinay V Belaval
Diagnosis almost certain

Presentation

Swelling of left shoulder region.

Patient Data

Age: 20 years
Gender: Male

MRI of the left shoulder shows a well-defined, heterogeneous multilocular cystic mass lesion in the subdeltoid bursa (occupying the entire bursal region) with multiple T2WI and T1WI hypointense fluid levels. No intraarticular extension. Mild edema is noted around the lesion as evident on PD-fat sat image.

The axial bone window of the left shoulder showed a heterogeneous calcified mass lesion in subdeltoid bursa with multiple hyperdense fluid levels - representing layered "milk of calcium". 

Case Discussion

This young patient presented with left shoulder swelling. 

MRI images showed a heterogeneous mass within the subdeltoid bursa showing sedimentation sign, which was confirmed on CT. Biochemical parameters were within normal limits. The diagnosis of "tumoral calcinosis of subdeltoid bursa" was made.

Tumoral calcinosis is a hereditary disorder of phosphate metabolism characterized by large, painless periarticular calcified masses predominantly involving the major joints. Secondary causes of dystrophic or metabolic calcifications should be ruled out. 

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