I have seen 2 cases that actually look very much like yours. We started at the wrong end with MR (and contrast) before we did the x-ray and CT, and were initially quite confused about this woman in her 70s who could not lift her arm at all.
CT particularly nice showed how the calcification "showered" into bone through a lytic defect at the pectoralis major insertion. I have also seen the same constellation of findings at the gluteus maximus insertion posteriorly on the proximal femur.
I enclose a few images from one of the cases. Funny how similar they are!
Best,
Roar
tir. 3. okt. 2023 kl. 20:03 skrev hilary umans <hilary.umans>:
The exam was ordered with an indication for evaluation of Rotator Cuff tear or Adhesive Capsulitis…adhesive capsulitis does not present with acute onset of severe pain—nor should RCT.
In this case the cuff is normal (not shown).
The degree of soft tissue edema surrounding a rounded dark signal focus in proximity to the biceps tendon is diagnostic for calcium hydroxyapatite deposition.
The deposit elevates the biceps tendon away from the humeral shaft
The red arrows indicate the intact Pec Major tendon, the white arrows indicate the LHBT and proximal MT junction
There is reactive ST edema in proximity to the biceps, the Ped major tendon and infiltrating the anterior deltoid muscle.
I have no prior images….but HADD becomes acutely symptomatic in the Resorptive Phase…and can mimic clinical symptoms of trauma or infection
I frequently see a history of antecedent stress or trauma….is that just the patients’ attempt to find a cause for the symptoms, or can stress / trauma provoke the Resorptive phase of HADD?
I don’t see this reported.
