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.
Highlights
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]
RCCT has an almost typical presentation: in most cases, calcific deposits appear as a dense opacity around the humeral head on conventional radiography (CR), as hyperechoic foci with acoustic shadow at US, and as a signal void at Magnetic resonance (MR)
As RC tears mostly present as hyperintense signal areas corresponding to fluid signal within the tendons on these sequences [61], we suggest that MR should be always assessed in presence of a previous CR or US examination in patients in whom RCCT is suspected
Summary
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]. Another atypical site of presentation of calcific tendinopathy is pectoralis major, again with few cases published on this condition (Fig. 11) In one of these case reports, the unusual presentation in the pectoralis tendon could lead to misdiagnosis of humeral chondroid neoplasm at imaging because of the bone marrow involvement and the cortical erosion showed by MR [70]. Calcific tendinopathy can be correctly diagnosed due to the presence of comet-tail or flame appearance of the calcification, described as a characteristic finding [39, 71, 72] Another case report underlined that cortical erosion is seen at areas of powerful traction, such as pectoralis major tendons, where the inflammation due to the mechanical effect of traction may result in bone resorption and tendon edema [73]. Another rare site of presentation of calcific tendinopathy can be the deltoid (Fig. 12), as this condition can probably involve every tendinous structure [74]
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