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Skeletal Radiology

, Volume 47, Issue 1, pp 131–136 | Cite as

Intraosseous migration of tendinous calcifications: two case reports

  • A. MarinettiEmail author
  • M. Sessa
  • A. Falzone
  • S. W. Della Sala
Case Report

Abstract

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain. Inflammation of the rotator cuff tendons may be complicated by adjacent bone erosion and subsequent migration of calcific deposits within the bone resulting in marrow inflammation. Bone marrow involvement is not readily visible using X-ray and ultrasound (US) and further testing is necessary. Magnetic resonance imaging (MRI) is a highly sensitive technique that can detect a focal bone T1 and T2-weighted hypointensity with bone marrow edema-like signal and cortical erosion. These findings can mislead the radiologist by suggesting an infectious or neoplastic lesion, often requiring further evaluation with computed tomography (CT) and biopsy. We report two cases of patients with shoulder pain in which different radiological approaches were used with pathological confirmation in one of them. In the first case, MRI revealed significant bone involvement in the head of the humerus and cortical erosion of the greater tuberosity. A CT examination and a biopsy was necessary for a final diagnosis of inflammatory bone reaction from intraosseous migration of tendinous calcifications. In the second case, similar MRI findings prompted re-evaluation of imaging to make a diagnosis of intraosseous migration of tendinous calcifications, obviating the need to perform CT and biopsy. We illustrate MRI signs of this complication that we think would allow to narrow the differential diagnosis potentially avoiding biopsy and additional CT examinations.

Keywords

Calcific tendinopathy of rotator cuff Complication Intraosseous migration MRI 

Notes

Acknowledgements

The authors acknowledge Dr. N. Agarwal, Radiology Department of S. Maria Hospital, Rovereto, for collaboration in text translation, Dr. G. Gordan and Dr. E. Bragantini, Pathological Anatomy Department, S. Chiara Hospital, Trento for the images in Fig. 2.

Compliance with ethical standards

Conflict of interest

The Authors declare that they have no conflict of interest.

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Copyright information

© ISS 2017

Authors and Affiliations

  • A. Marinetti
    • 1
    Email author
  • M. Sessa
    • 1
  • A. Falzone
    • 1
  • S. W. Della Sala
    • 1
  1. 1.Department of RadiologySanta Maria del Carmine HospitalRoveretoItaly

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