Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls
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MUSCULOSKELETAL RADIOLOGY
Imaging of calcific tendinopathy around the shoulder: usual and unusual presentations and common pitfalls Domenico Albano1,2 · Alessandra Coppola3 · Salvatore Gitto4 · Santi Rapisarda1 · Carmelo Messina1,4 · Luca Maria Sconfienza1,4 Received: 4 May 2020 / Accepted: 20 October 2020 © The Author(s) 2020
Abstract Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon. RCCT has a typical imaging presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography, as hyperechoic foci with or without acoustic shadow at ultrasound and as a signal void at magnetic resonance imaging. However, radiologists have to keep in mind the possible unusual presentations of RCCT and the key imaging features to correctly differentiate RCCT from other RC conditions, such as calcific enthesopathy or RC tears. Other presentations of RCCT to be considered are intrabursal, intraosseous, and intramuscular migration of calcific deposits that may mimic infectious processes or malignancies. While intrabursal and intraosseous migration are quite common, intramuscular migration is an unusual evolution of RCCT. It is important also to know atypical regions affected by calcific tendinopathy as biceps brachii, pectoralis major, and deltoid tendons. Unusual presentations of RCCT may lead to diagnostic challenge and mistakes. The aim of this review is to illustrate the usual and unusual imaging findings of RCCT that radiologists should know to reach the correct diagnosis and to exclude other entities with the purpose of preventing further unnecessary imaging examinations or interventional procedures. Keywords Calcific tendinopathy · Rotator cuff · Ultrasound · Conventional radiography · Magnetic resonance · Pitfall
Introduction Rotator cuff calcific tendinopathy (RCCT) is a very common condition, characterized by calcium deposition over fibrocartilaginous metaplasia of tenocytes, mainly occurring in the supraspinatus tendon [1–3]. The prevalence of RCCT has
* Domenico Albano [email protected] 1
IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Via Riccardo Galeazzi 4, 20161 Milan, Italy
2
Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy
3
Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122 Milan, Italy
4
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milan, Italy
been reported to range from 2.7% to 10.3% [4–7]; ∼50% of these patients eventually become symptomatic [8]. The cause of RCCT is not completely understood. It is likely related to a low oxygen tension inside the tendon, although hormonal status may play a role, since RCCT is far
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