Radsource radiologists are constantly communicating and sharing knowledge with each other. In our blog series Today’s Interesting Case, our team will post notable cases and images for discussion from time to time.
Today we are reviewing the case of a 52 year-old male presenting with severe shoulder pain for 2 years.
A fat-suppressed T2-weighted image demonstrates a low signal intensity focus along the bursal side of the supraspinatus compatible with hydroxyapatite deposition (calcific bursitis). Intramuscular edema is present within the supraspinatus as well.
A more posterior coronal image (below) reveals the source of the edema, as large deposits of hydroxyapatite are present within the muscle belly, presumably having extended into the muscle through interstitial splits.
As Dr. Stephen Quinn explains in the web clinic on Hydroxyapatite Deposition Disease, “HADD is a common disorder hallmarked by peri-articular deposition of CHA crystals and an accompanying inflammatory process.”
Today’s case is fascinating as it is quite rare to see hydroxyapatite deposition disease with this degree of intramuscular involvement. The associated edema indicates that the process is active, and almost certainly accounts for the patient’s pain.