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Opper S, Uchin J, He L. Test yourself answer: progressive right thumb pain and swelling. Skeletal Radiol 2023; 52:1069-1072. [PMID: 36409322 DOI: 10.1007/s00256-022-04231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Sonja Opper
- Department of Radiology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA, 15212, USA.
| | - Jeffrey Uchin
- Department of Pathology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212, USA
| | - Lulu He
- Department of Radiology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA, 15212, USA
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2
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Guo D, Yang J, Liu X. Surgical management of chronic calcific deposit resembling tendon sheath infection in the index finger: A rare case report and literature review. Front Surg 2023; 10:1119612. [PMID: 37151858 PMCID: PMC10154564 DOI: 10.3389/fsurg.2023.1119612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Background Calcific tendonitis rarely occurs in the fingers, and it is easily misdiagnosed. Herein we describe the case of a patient with multiple calcific lesions within the flexor digitorum superficialis and the extensor digitorum tendons of the distal interphalangeal joints of the right index finger, and the surgical treatment of those lesions. Case presentation The patient was a 66-year-old man who reported pain and swelling in his right index finger for one year. He was diagnosed with chronic calcific tendonitis based on his symptoms and radiology images. He was successfully treated surgically, and histopathological examination confirmed the diagnosis. After one month, the patient had healed well, and there was no recurrence. Conclusions This is the first report of a patient suffering from chronic calcific tendonitis in a finger who failed conservative treatment and was successfully treated with surgery. The outcome demonstrates that surgical debridement can yield a good outcome in patients with chronic calcific tendonitis.
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Affiliation(s)
- Deming Guo
- Orthopaedic Medical Center, Second Hospital of Jilin University, Changchun, China
| | - Jingjing Yang
- Operating Room, Second Hospital of Jilin University, Changchun, China
| | - Xiaoning Liu
- Orthopaedic Medical Center, Second Hospital of Jilin University, Changchun, China
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Krolikowski M, Vargas CR, Chepla KJ, DiLorenzo D. Mass-like calcific peri-arthritis in the wrist: a rare case presenting as acute carpal tunnel syndrome and requiring surgical intervention. Skeletal Radiol 2022; 51:1883-1888. [PMID: 35149897 DOI: 10.1007/s00256-022-04003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
Hydroxyapatite deposition disease (HADD) is a common localized disorder characterized by deposition of hydroxyapatite in soft tissues. These hydroxyapatite deposits can be found in the periarticular soft tissues such as bursae, joint capsules, tendon sheaths, and ligaments as well as within the tendons themselves, and intra-articular involvement has also been described [1,2]. We present a case of a 50-year-old female with acute symptoms of carpal tunnel syndrome secondary to partially liquified, mass-like, inflammatory calcific peri-arthritis. The case is supplemented with the use of multimodality imaging, a surgical perspective, and histopathologic correlation.
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Affiliation(s)
- Michal Krolikowski
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Christina R Vargas
- Department of Surgery, Division of Plastic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kyle J Chepla
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David DiLorenzo
- Department of Radiology, Department of Pathology, Department of Surgery, Division of Plastic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Parsaoran Butarbutar JC, Suginawan ET. Calcified Tendinitis of the Flexor Carpi Ulnaris Tendon: A Case Report. J Orthop Case Rep 2022; 12:10-13. [PMID: 36659882 PMCID: PMC9826684 DOI: 10.13107/jocr.2022.v12.i07.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/10/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Calcification in the tendon (Calcific Tendinitis) occurs commonly in the shoulder, but this condition can happen in other tendon sites. Calcific tendinitis of the hand and wrist occurs rarely, which causes unfamiliarity toward the disease. With the symptoms mimicking other causes, misdiagnosis often happens. This can cause ineffective and over treatment. Case Report A 51-year-old man presented with a 2-week-pain on his right wrist with localized erythema and tenderness on physical examination. Imaging with ultrasound and X-ray shows calcification on the flexor carpi ulnaris tendon. Patient was treated with splinting for 2 weeks and NSAID for pain management and was free of pain afterwards. Conclusion Calcific tendinitis mimics the symptoms of various causes. The ability to differentiate this entity to other differential diagnosis leads to an effective and precise treatment.
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Affiliation(s)
- John Christian Parsaoran Butarbutar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals Lippo Village, Tangerang, Indonesia,Address of Correspondence: Dr. John Christian Parsaoran Butarbutar, Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospital Lippo Village, Tangerang, Indonesia. E-mail:
| | - Earlene Tasya Suginawan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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Chua E, Shah D. Hydroxyapatite crystal deposition disease around the hip: a rare cause of piriformis syndrome and ischiofemoral impingement. BJR Case Rep 2022; 7:20210075. [PMID: 35300243 PMCID: PMC8906143 DOI: 10.1259/bjrcr.20210075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/31/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022] Open
Abstract
Hydroxyapatite crystal deposition disease (HADD) around the hip is typically described involving the gluteal tendons. However, HADD can occur in any location and result in varied clinical presentations. Even with small deposits, symptoms can be significant and imaging findings may appear aggressive, mimicking infection and malignancy particularly when in an atypical location. We illustrate cases of both common and rare locations of HADD around the hip, in particular presenting as greater trochanteric pain syndrome, piriformis syndrome and ischiofemoral impingement. The latter two manifestations have not been previously described in the literature. Low signal deposits were identified on MRI at the greater trochanter (gluteus medius tendon), proximal piriformis (adjacent to the sciatic nerve), and quadratus femoris (in the ischiofemoral space), respectively. Associated inflammatory changes with tendinopathy, bursitis and oedema were also demonstrated. The patient with piriformis syndrome underwent steroid injections and shockwave therapy with significant symptom improvement. HADD should be within the differential diagnosis for hip pain and nerve compression syndromes. Knowledge of tendon anatomy and correlation with radiographs or CT, even after MRI, is crucial in recognising unusual manifestations and preventing unnecessary investigation. Therefore, we review the spectrum of imaging features of HADD, as well as the current evidence on its management, to confidently diagnose this condition.
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Affiliation(s)
- Elise Chua
- Department of Radiology, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Dhiren Shah
- Department of Radiology, London North West University Healthcare NHS Trust, London, United Kingdom
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6
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[Retropharyngeal tendinitis : Rare differential diagnosis of acute neck pain]. Unfallchirurg 2022; 125:909-914. [PMID: 35024872 PMCID: PMC8756746 DOI: 10.1007/s00113-021-01138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
Atraumatische Nackenschmerzen sind ein häufiger Vorstellungsgrund für Patienten in der Notaufnahme. Für die behandelnden Ärzte ist dabei der Ausschluss möglicherweise lebensbedrohlicher Erkrankungen, wie Spondylodiszitis, retropharyngealer Abszess oder Meningitis, oft eine große Herausforderung. In dieser Kasuistik wird der seltene Fall der retropharyngealen Tendinitis vorgestellt, einer wenig bekannten und dadurch sicherlich unterdiagnostizierten Entität. Sie ist charakterisiert durch einen stark reduzierten Bewegungsumfang der HWS, erhöhte Infektparameter und einen pathognomonischen MRT-Befund. Zusätzlich zur Fallpräsentation soll im Rahmen eines kurzen Reviews die Charakteristik der retropharyngealen Tendinitis noch genauer dargestellt werden. So ist es das Ziel dieser Arbeit, die behandelnden Ärzte für dieses Krankheitsbild zu sensibilisieren, um in Zukunft falsche bzw. unnötige Therapien zu vermeiden.
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7
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Laucis NC, Rosen KA, Thodge A, Leschied JR, Klochko CL, Soliman SB. Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison. Clin Rheumatol 2021; 40:2897-2905. [PMID: 33479863 DOI: 10.1007/s10067-021-05597-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT. METHOD In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears. RESULTS RC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14). CONCLUSIONS In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT. Key Points • Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy. • The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear. • Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears. • Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.
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Affiliation(s)
- Nicholas C Laucis
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Kelli A Rosen
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Anay Thodge
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Jessica R Leschied
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Chad L Klochko
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
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Lombard C, Gillet R, Rauch A, Germain E, Dodin G, Blum A, Teixeira PG. Hallux sesamoid complex imaging: a practical diagnostic approach. Skeletal Radiol 2020; 49:1889-1901. [PMID: 32583133 DOI: 10.1007/s00256-020-03507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/02/2023]
Abstract
A wide variety of pathologies can affect the hallux sesamoid complex of the foot, including traumatic, micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic conditions. Symptoms are quite nonspecific, mainly related to pain in the plantar surface of the first metatarsal head. In this context, imaging is important for the etiologic diagnosis of hallux sesamoid complex pathology with implications in patient management. The hallux sesamoid complex has a complex anatomy, and pathologic processes of this region are poorly known of radiologists. Besides, some entities such as "sesamoiditis" remain poorly defined in the literature. Schematically, conditions affecting sesamoids will be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones). Thus, in this article, after a review of anatomical key points and pathologies affecting the hallux sesamoid complex, a practical multimodality approach for the diagnosis of hallux sesamoid pathologies will be proposed.
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Affiliation(s)
- Charles Lombard
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France.
| | - Romain Gillet
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Aymeric Rauch
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Edouard Germain
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Gauthier Dodin
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
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Cho N, Lee SG, Kim JO, Kim YA, Kim EM, Park C, Ji JH, Kim KK. Identification of Differentially Expressed Genes Associated with Extracellular Matrix Degradation and Inflammatory Regulation in Calcific Tendinopathy Using RNA Sequencing. Calcif Tissue Int 2020; 107:489-498. [PMID: 32776213 DOI: 10.1007/s00223-020-00743-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/31/2020] [Indexed: 12/19/2022]
Abstract
Calcific tendinopathy (CT), developed due to calcium hydroxyapatite deposition in the rotator cuff tendon, mostly affects women in their 40 s and 50 s and causes severe shoulder pain. However, the molecular basis of its pathogenesis and appropriate treatment methods are largely unknown. In this study, we identified 202 differentially expressed genes (DEGs) between calcific and adjacent normal tendon tissues of rotator cuff using RNA sequencing-based transcriptome analysis. The DEGs were highly enriched in extracellular matrix (ECM) degradation and inflammation-related processes. Further, matrix metalloproteinase 9 (MMP9) and matrix metalloproteinase 13 (MMP13), two of the enzymes associated with ECM degradation, were found to be highly upregulated 25.85- and 19.40-fold, respectively, in the calcific tendon tissues compared to the adjacent normal tendon tissues. Histopathological analyses indicated collagen degradation and macrophage infiltration at the sites of calcific deposit in the rotator cuff tendon. Our study acts as a foundation that may help in better understanding of the pathogenesis associated with CT, and thus in better management of the disease.
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Affiliation(s)
- Namjoon Cho
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea
| | - Sung-Gwon Lee
- School of Biological Science and Technology, Chonnam National University, Gwangju, Republic of Korea
| | - Jong Ok Kim
- Department of Pathology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yong-An Kim
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea
| | - Eun-Mi Kim
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Chungoo Park
- School of Biological Science and Technology, Chonnam National University, Gwangju, Republic of Korea.
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
| | - Kee K Kim
- Department of Biochemistry, College of Natural Sciences, Chungnam National University, Daejeon, Republic of Korea.
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Phan M, Birkemeier K, George R, Garza-Gongora R, Crisp M, Trotter B, Haghshenas V. Calcific tendonitis of the flexor pollicis longus tendon at the thumb interphalangeal joint in childhood. Proc (Bayl Univ Med Cent) 2020; 34:309-311. [PMID: 33678974 DOI: 10.1080/08998280.2020.1834805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In rare instances, calcific tendonitis may manifest in the pediatric population as inflammatory calcium hydroxyapatite deposition. To our knowledge, there have been no previous case reports involving the flexor pollicis longus tendon at the thumb interphalangeal joint. We present a 9-year-old boy with a painful mass at the right thumb interphalangeal joint. Initial radiographs revealed a 7-mm ovoid calcific mass along the volar soft tissues of the thumb interphalangeal joint. Subsequent ultrasound and magnetic resonance findings further confirmed calcification with surrounding edema. Because the pain was limiting the patient's school activities, his family elected for excisional biopsy of the calcific mass. Pathology ultimately revealed prominent dystrophic calcifications with surrounding granulomatous inflammation, consistent with calcific tendonitis.
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Affiliation(s)
- Mimi Phan
- College of Medicine, Texas A&M Health Science Center, Houston, Texas
| | - Krista Birkemeier
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Reshma George
- College of Medicine, Texas A&M Health Science Center, Houston, Texas
| | - Ricardo Garza-Gongora
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Matthew Crisp
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Bradley Trotter
- Department of Radiology, Texas A&M Health Science Center and Baylor Scott & White McLane Children's Medical Center, Temple, Texas
| | - Varan Haghshenas
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas
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11
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Yamamoto N, Watari T, Kawasaki K, Matsui Y, Ozaki T. Acute Calcific Retropharyngeal Tendinitis with Eggshell-like Calcification: Case Report and Literature Review on Time-course Changes in Imaging Findings. Cureus 2020; 12:e7611. [PMID: 32399345 PMCID: PMC7213671 DOI: 10.7759/cureus.7611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute calcific retropharyngeal tendinitis is a rare disease, and few studies have reported the radiological findings of its time-course in detail. These radiological findings vary according to the calcific stage. We report a case of acute calcific retropharyngeal tendinitis with eggshell-like calcification detected on follow-up computed tomography (CT). We also review pertinent literature on calcific retropharyngeal tendinitis, with a focus on time-course changes in imaging findings. A 54-year-old Japanese woman presented with acute severe neck pain. She also had a limited range of motion in the rotation of her neck and moderate pain and discomfort during swallowing. Plain radiographs of the cervical spine showed no apparent abnormality. CT revealed massive retropharyngeal calcification in front of the C1-C2 vertebrae. The patient was diagnosed with acute calcific retropharyngeal tendinitis and treated with a soft collar and non-steroidal anti-inflammatory drugs. Two weeks later, the neck pain and dysphagia improved. At the one-month follow-up, CT showed residual marginal calcification, which was diminishing in size, suggesting eggshell-like calcification. We believe that although the eggshell calcification appearance is extremely rare, it is important to note this atypical presentation of acute calcific retropharyngeal tendinitis.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Unnan City Hospital, Unnan, JPN
| | - Takashi Watari
- Department of Internal Medicine, Postgraduate Clinical Training Center, Shimane University Hospital, Izumo, JPN
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, JPN
| | - Yuzuru Matsui
- Department of Orthopedic Surgery, Unnan City Hospital, Unnan, JPN
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, JPN
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12
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Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies. Eur J Radiol 2019; 120:108653. [PMID: 31550638 DOI: 10.1016/j.ejrad.2019.108653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Calcium hydroxyapatite depositional disease (HADD) is usually asymptomatic and self-limiting; however, when there is an associated inflammatory process or HADD occurs in an unusual location, it may mimic trauma, infection, or neoplasm. The purpose of this article is to review the imaging features of HADD and how to distinguish it from more worrisome entities that can have similar appearances. CONCLUSION An understanding of the presentations of HADD is important to allow early and confident diagnosis. In particular, familiarity with presentations that resemble more ominous pathologies is essential to avoid costly and time-consuming workup or intervention.
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13
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Bianchi S, Becciolini M. Ultrasound Appearance of the Migration of Tendon Calcifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2493-2506. [PMID: 30653700 DOI: 10.1002/jum.14933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/12/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
Calcific tendinopathy (CTe) is a frequent disorder related to the deposition of calcium hydroxyapatite crystals within tendons. Ultrasound has been shown to be an excellent imaging modality for the evaluation of CTe. During the resorptive phase of CTe, calcium deposits may migrate inside the tendons or in neighboring tissues and lead to local inflammation and severe pain. In this pictorial essay, we describe the ultrasound appearance of a spectrum of CTe migrations. Knowledge of the different migration patterns can help sonologists in their detection and in establishing the correct diagnosis.
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14
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Kim J, Bae KJ, Lee DW, Lee YH, Gong HS, Baek GH. Effective period of conservative treatment in patients with acute calcific periarthritis of the hand. J Orthop Surg Res 2018; 13:287. [PMID: 30428905 PMCID: PMC6236998 DOI: 10.1186/s13018-018-0997-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective. METHODS We retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3 months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9 months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval. RESULTS All 10 patients with 17 affected joints continued conservative treatments for an average of 11.1 months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9 months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6 months, but not at 9 months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6 months, but not at 9 months (P values = 0.020, 0.034, and 0.083, respectively). CONCLUSIONS Patients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6 months. These results suggest that conservative treatment could be tried for at least 6 months before considering the surgical treatment of calcific periarthritis of the hand.
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Affiliation(s)
- Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kee Jeong Bae
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Yo-Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
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