Left Hip radiography-Left hip joint negative. Probable tendinous calcification adjacent to the posterior left subtrochanteric femur. Lumbosacral facet arthritis. Case Photo #1
Left Hip Diagnostic Ultrasound (US) - Scan of the gluteus maximus insertion confirmed intratendinous calcification at the subtrochanteric insertion without surrounding hyperemia. The calcium deposit measured 16 x 10 x 5 mm (craniocaudal (CC) x anteroposterior (AP) x medial-lateral (ML)). There was also a focal irregularly bordered area of an anechogenicity measured 9 x 8 x 4 mm (AP x CC x ML) in the superficial gluteus maximus tendon insertion, immediately superficial to the calcification without compressible fluid or hyperemia. Findings consistent with a chronic gluteus maximus partial-thickness tendon tear and subjacent intratendinous calcification. The tenderness to palpation correlated exactly with both superimposed lesions. Coupled with the sudden onset of pain, this may represent a chronic gluteus maximus tendon insertion tear with associated heterotopic ossification.
Case Photo #2 - Longitudinal US image of the left posterior infratrochanteric hip showing the gluteus maximum (GM) tendon with a hypoechogenic partial thickness intrasubstance tear (superficial) and a hyperechoic calcification (deep), which measures 16 x 10 x 5 mm (CC x AP x ML) adjacent to the femur (arrows). The patient's typical pain was reproduced with sonopalpation over the superimposed lesions. Top = superficial, Bottom = deep, Left = distal, Right = proximal, T= tear, C= calcification
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