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Rush C, Jochl O, Lowenstein N, Mazzocca J, Matzkin E. Bilateral Subacromial-Subdeltoid Rice Bodies in the Shoulder: A Surgical Case Report. Case Rep Orthop 2024; 2024:8299485. [PMID: 38601875 PMCID: PMC11006454 DOI: 10.1155/2024/8299485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/26/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Rice bodies (RBs) are pale and glossy appearing small fibrinous nodules that form due to synovial or tenosynovial joint inflammation. RBs are significant as they are common in orthopedic practices causing nonspecific symptoms such as pain, swelling, range of motion limitations, crepitus, and catching sensations. These loose bodies occur often within the bursa as a symptom of chronic bursitis and are commonly associated with rheumatoid, inflammatory, or tuberculous arthritis. Reports on RBs are present; however, few bilateral cases within the shoulder appear in the literature. Case Presentation. This case demonstrates an unusual bilateral, subacromial-subdeltoid presentation of rice bodies (RBs) in a 41-year-old Caucasian female patient with a history of rheumatoid arthritis. We describe treatment with right shoulder arthroscopy to remove the loose bodies. One-year postoperative patient-reported outcomes (PROMs) show improvement in symptoms, pain, and overall function. Conclusion Formation of RBs occurs as a symptom of an inflammatory response in synovial joints. This provokes multiple small fibrin aggregates to collect within synovial bursae and occasionally tendon sheaths. RBs are rarely seen bilaterally. Arthroscopic removal of RBs is an appropriate treatment method for symptom improvement.
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Affiliation(s)
- Caroline Rush
- Science Division, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Olivia Jochl
- Research Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalie Lowenstein
- Research Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Public Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jillian Mazzocca
- Research Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth Matzkin
- Women's Sports Medicine, Surgery Division, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Qi W, Ren Y, Wang H, Wan Y, Pan H, Yao J. Candida parapsilosis-Caused Arthritis with Rice Body Formation: A Case Presentation and Literature Review. Infect Drug Resist 2023; 16:4123-4135. [PMID: 37396064 PMCID: PMC10312336 DOI: 10.2147/idr.s416990] [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: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
A 68-year-old male patient came to the orthopedics department because of swelling and pain in his left shoulder joint. He received more than 15 intraarticular steroid injections in the shoulder joint at a local private hospital. MRI showed that the synovial membrane of the joint capsule was thickened and swollen, and there were extensive "rice body-like" low T2 signal shadows filling. Arthroscopic removal of rice bodies and subtotal bursectomy were performed. The observation channel was placed through the posterior approach, and a large amount of rice bodies in yellow bursa fluid were observed to flow out. Rice bodies with a diameter of approximately 1-5 mm filled the joint cavity were seen in the observation channel. The histopathological examination of the rice body showed that it was mainly composed of fibrin without a clear tissue structure. Bacterial and fungal cultures of synovial fluid suggested Candida parapsilosis infection, so the patient received antifungal treatment. However, the shoulder swelled again after three weeks, MRI revealed that there was significant fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating and ultrasound examination showed joint cavity effusion, synovial hyperplasia, and some synovium looked like "floating weeds". After 2 weeks, there were recurrent rice bodies in the articular cavity. Arthroscopic surgery was performed again to clean the joint and a catheter was placed for irrigation and drainage, and a large amount of necrotic synovial tissue floating as seen in ultrasound. Finally, patient received sensitive antifungal treatment and did not relapse within 6 months. During the recurrence in the current case, we recorded the process of rice body formation, which has for the first time been reported.
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Affiliation(s)
- Weihui Qi
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Yanyun Ren
- Department of Stomatology No. 903 Hospital of PLA, Hangzhou, People’s Republic of China
| | - Huang Wang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Yue Wan
- Department of Stomatology No. 903 Hospital of PLA, Hangzhou, People’s Republic of China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Jun Yao
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
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Skelly DL, Konieczko EM, Ulrich J. Rice bodies in a shoulder bursa: a cadaveric and histologic case report. J Man Manip Ther 2023; 31:206-213. [PMID: 36309809 PMCID: PMC10288894 DOI: 10.1080/10669817.2022.2138153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature. METHODS A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment. RESULTS The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes. CONCLUSIONS Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.
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Yip SWY, Griffith JF. Image-guided synovial biopsy with a focus on neoplastic lesions. Skeletal Radiol 2023; 52:817-829. [PMID: 35869325 DOI: 10.1007/s00256-022-04094-6] [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: 04/30/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Image-guided synovial biopsy is generally a safe, well-tolerated procedure, with a high diagnostic yield. Percutaneous biopsy is indicated for synovial tumours visible on imaging studies where a definitive diagnosis is not possible on imaging grounds alone and/or when a definite diagnosis is necessary prior to initiating long-term treatment. Synovial biopsy for suspected synovial tumour differs from the technique used for joint aspiration, where the most convenient path between the skin and joint is usually chosen and, also, to a lesser degree, to that used for non-tumoural synovial biopsy. During synovial biopsy for tumour, the needle path should be aligned so that it passes along the length of the synovial tumour, including for suspected malignant tumours, the planned resection plane whenever possible. This review outlines the approach to image-guided biopsy of joint synovial tumours.
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Affiliation(s)
- Stefanie W Y Yip
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong.
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El-Rosasy MA, Elrosasy AM, Khaled A. Carpal Tunnel Syndrome Secondary to Tuberculous Tenosynovitis With Rice Bodies: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00041. [PMID: 37267417 DOI: 10.2106/jbjs.cc.23.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CASE We report the case of a 34-year-old African man who presented with severe symptoms of recurrent left carpal tunnel syndrome (CTS) and left hand swelling after previous open decompression. Considering the recurrent unilateral affection of the left hand in a patient working in a slaughterhouse in an area with a moderate burden for tuberculosis, tuberculous infection was suspected. Open surgery and biopsy revealed tuberculous tenosynovitis of flexor tendon sheath and shiny white rice bodies. CONCLUSION Tuberculous tenosynovitis should be considered as a differential diagnosis of the CTS when there is evidence of proliferative tenosynovitis in patients from an endemic area for tuberculosis.
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Affiliation(s)
- Mahmoud A El-Rosasy
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Abdullah Khaled
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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Kanayama Y, Tono T, Tanaka T, Yamaoka K. A case of rheumatoid arthritis with bilateral shoulder bursitis accompanied by gas image. Mod Rheumatol Case Rep 2023; 7:14-18. [PMID: 35467748 DOI: 10.1093/mrcr/rxac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 04/17/2022] [Indexed: 01/07/2023]
Abstract
We experienced a case of bilateral shoulder bursitis with gas images in a rheumatoid arthritis (RA) patient. A 60-year-old man with RA had been treated with weekly methotrexate 10 mg and daily prednisolone (PSL) 10 mg for 7 months. Generalized pain, especially in the bilateral shoulder joints, developed and exacerbated daily with increased C-reactive protein (CRP) level. Despite the initiation of biweekly sarilumab 200 mg, joint symptoms and CRP level continued to worsen. Computed tomography (CT) scan to determine the cause of severe shoulder inflammation revealed low absorption areas with contrast effects at the margins around the bilateral shoulder joints, accompanied by internal gas images. In addition, magnetic resonance imaging demonstrated subacromial bursae and coracoid bursae and bursitis, leading to the suspicion of abscess formation depending on the presence of gas image. In spite of antimicrobial therapy, arthralgia did not improve, and a CT-guided arthrocentesis of the left shoulder joint resulted in negative findings of infection in culture and pathological examinations. Switching treatment to intensive anti-inflammatory therapy with high-dose steroids and etanercept finally improved symptoms and CRP levels associated with the reduction of low absorption areas and disappearance of gas images at bilateral shoulder joints. Our case indicated that bursitis with gas image in RA patients involves unusual pathophysiology and requires intensive anti-rheumatic treatment.
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Affiliation(s)
- Yoshiro Kanayama
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshihiro Tono
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoki Tanaka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
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Root KT, Wright JO, Mandato N, Stewart BD, Moser MW. Subacromial-Subdeltoid Bursitis With Rice Bodies After Rotator Cuff Repair With a Collagen Scaffold Implant: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00025. [PMID: 36735809 DOI: 10.2106/jbjs.cc.22.00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023]
Abstract
CASE We report the second-known case of subacromial-subdeltoid bursitis with rice bodies after rotator cuff repair with a Smith + Nephew REGENETEN bovine-derived bioinductive collagen scaffold implant. After the removal of rice bodies and a portion of implant that had not incorporated, the patient recovered well and made a full return to work and recreational activities. CONCLUSION This case demonstrates that persistent pain, swelling, or decreased range of motion for several months after rotator cuff repair with the use of a collagen implant may warrant a relatively early magnetic resonance imaging to evaluate for underlying pathology. It also provides a framework for physicians who may see similar patients in the future.
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Affiliation(s)
- Kevin T Root
- College of Medicine, University of Florida, Gainesville, Florida
| | - Jonathan O Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
| | | | - Brian D Stewart
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Michael W Moser
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
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Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
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Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
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Iga N, Fuchimoto Y, Koyanagi T, Mizuno D, Nishi H. A rare case of chest wall tuberculosis: Tuberculous scapulothoracic bursitis. Respir Med Case Rep 2021; 34:101537. [PMID: 34745872 PMCID: PMC8551644 DOI: 10.1016/j.rmcr.2021.101537] [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: 08/02/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Chest wall tuberculosis is a relatively rare extrapulmonary tuberculosis, and is often difficult to diagnose and treat because of the lack of symptoms. The scapulothoracic joint is a special joint that does not have a joint capsule, cartilage, or synovial membrane but consists of muscle and bursa. Tuberculosis infection of the scapulothoracic joint is an extremely rare musculoskeletal tuberculosis of the chest wall. Herein, we present the diagnosis and treatment strategy for tuberculous scapulothoracic bursitis in an 82-year-old man who was successfully treated.
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Affiliation(s)
- Norichika Iga
- Department of Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama, 702-8055, Japan
| | - Yasuko Fuchimoto
- Department of Respiratory medicine, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama, 702-8055, Japan
| | - Taisaku Koyanagi
- Department of Respiratory medicine, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama, 702-8055, Japan
| | - Daisuke Mizuno
- Department of Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama, 702-8055, Japan
| | - Hideyuki Nishi
- Department of Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama, 702-8055, Japan
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Fice M, Patel V, Solarewicz J, Gusho C, Miller I, Blank A. Subdeltoid Rice Bodies in a Patient with Rheumatoid Arthritis on Disease Modifying Antirheumatic Drug Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00118. [PMID: 34115659 DOI: 10.2106/jbjs.cc.20.00879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 58-year-old man with rheumatoid arthritis (RA) on disease modifying antirheumatic drug therapy presented with chronic right shoulder pain. Magnetic resonance imaging was concerning for rice body disease which was confirmed through histology after intraoperative deltoid bursa resection. CONCLUSIONS Rice bodies can develop regardless of RA symptom severity or the degree of RA medical therapy administered. Therefore, physicians should not disregard rice bodies as a possible cause of symptoms in individuals on appropriate RA medical therapy or who are demonstrating adequate RA symptom and flair control.
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Affiliation(s)
- Michael Fice
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Vishal Patel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joanna Solarewicz
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Charles Gusho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Alan Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Rice bodies in a pediatric patient with juvenile idiopathic arthritis and latent tuberculosis: case report and literature review. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bacha R, Manzoor I, Gilani SA. Sonographic presentation of rice bodies in subacromial-subdeltoid chronic bursitis. Ultrasound J 2019; 11:16. [PMID: 31359207 PMCID: PMC6643005 DOI: 10.1186/s13089-019-0130-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background subacromial-subdeltoid chronic bursitis is one of the main causes of shoulder pain syndrome. There are various causes of shoulder pain syndrome including chronic bursitis. The sonographic appearances of chronic bursitis vary from patient to patient, depending upon the underlying cause. However, rice bodies are the rare sonographic presentation among them. Rice bodies can be associated with atypical mycobacterial tenosynovitis, bursitis, mycobacterium tuberculosis and infections, but very rarely occur in the chronic subacromial-subdeltoid bursitis. Its unique sonographic presentation makes it easy to be diagnosed confidently, but it is difficult to be recognized, interpret and distinguish from other pathologies due to its rare occurrence. It is therefore intended to present this rare and interesting sonographic presentation of chronic subacromial-subdeltoid bursitis as a case report. Case-presentation A 36-year-old male suffering from swelling and pain on his left shoulder for 6 months came to the clinic with Grade-3 impingement syndrome. Free-floating echogenic rice bodies were identified in the subacromial-subdeltoid bursa during ultrasound examination, which was also confirmed with Magnetic resonance imaging (MRI) and serological tests of the specimen after surgery. Conclusion The unique sonographic presentation of rice bodies in the chronic subacromial-subdeltoid bursitis makes it easy to be diagnosed confidently, but it is difficult to be recognized, due to its rare occurrence. Electronic supplementary material The online version of this article (10.1186/s13089-019-0130-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), Faculty of Allied Health Sciences (FAHS), The University of Lahore, Lahore, Pakistan
| | - Iqra Manzoor
- University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), The University of Lahore, G 10\2 Canal Berg, Lahore, 54000, Pakistan.
| | - Syed Amir Gilani
- Dean Faculty of Allied Health Sciences (FAHS), The University of Lahore, Lahore, Pakistan
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