Acute calcific tendinitis of the rectus femoris associated with intraosseous involvement: a case report with serial CT and MRI findings

Abstract

Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the rectus femoris origin. Mostly reported cases were occurred in the reflected head of the rectus femoris, and only few cases were in the direct head of the rectus femoris. Intraosseous marrow involvement of calcific tendinitis is a more rare condition; it often goes misdiagnosed as an infection or a neoplasm. We report a rare, unusual case of acute calcific tendinitis of the direct head of the rectus femoris associated with intraosseous marrow involvement of calcification in anterior inferior iliac spine with serial CT and MRI findings. Aggressive osseous change may occur in acute calcific tendinitis of the rectus femoris as in this case which should be made an appropriate diagnosis to avoid unnecessary investigation and overtreatment like a surgery.

Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series

“…The clinical course probably does not differ much from that of other symptomatic forms of calcific tendinitis, generally improving after a few weeks or months [1,2,23,25]. In an arthroscopic series, the presence of osseous lesions seems to correlate with more severe symptoms and with less improvement after treatment [28].…”

“…c, d T1-and FS T2-weighted MR images, respectively, confirm this erosion, which is accompanied by edema-like high signal intensity of the bone marrow on FS T2-weighted sequences the spontaneous disappearance of a large calcification (15 mm) documented on radiography and MRI in the greater tuberosity of the humerus. Later, a few other isolated cases were reported affecting the greater tuberosity of the humerus [2,[22][23][24] or the anterior inferior iliac spine [25]. Several examples affecting the greater tuberosity of the humerus were also illustrated in review articles and book chapters [5,7,20,26].…”

Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins

“…The tendon appears hypoechoic and thickened around a poorly defined hyperechoic calcification without posterior acoustic shadowing on sonography (Figure ), with possible intratendinous Doppler hyperemia. Conversely, the acute phase of resorption may mimic hip septic arthritis, with sudden onset of pain and motion limitation . Physical signs are similar to those of acute synovitis or septic arthritis, contrasting with normal laboratory results.…”

Calcium Apatite Deposition Disease: Diagnosis and Treatment

“…Rectus femoris calcific tendinitis typically presents as focal tenderness over the anterior-inferior iliac spine and limited flexion of the hip [71]. Symptoms can be quite severe and confused for labral tear or septic hip joint [19, 72, 73].…”