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Here we have a case of a 48-year-old diabetic female

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who presents with right hip pain fever, leukocytosis

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and elevated sed rate.

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And here on our frontal projection radiograph, we see

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that in the subtrochanteric region there is a focus

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of calcification adjacent to the bone in this person

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that finding was not recognized.

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And then further workup pursued

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with cross-sectional imaging.

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Under ct, we see an amorphous area of that calcification,

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but also obscured fat planes about it with some areas

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of infiltration of the fat, reflecting some

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peral soft tissue edema shown here.

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And so what this represents is calcific tendonitis,

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also known as hydroxy appetite deposition disease, or HADD.

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And this relates

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to typically the extra articular deposition of calcium.

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So Baum calcium phosphates, the particular type

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that we see in the body is hydroxy appetite.

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And as I've already kind of alluded to,

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there are many synonyms for these.

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When they're symptomatic,

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they can be called hydroxyapatite deposition disease,

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calcific tendonitis, or because it's surrounding a joint

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or near joint, it may be also called

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calcific peri arthritis.

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But these are usually, uh, extra articular.

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So it's not the intraarticular mineralization

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that you would identify with chondro, calcinosis

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or potentially intraarticular bodies.

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So when you see a per articular calcification,

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it often is incidental.

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Again, if somebody's coming in for acute trauma, it may be

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that there is some kind of chronic calcific tendonitis,

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you get a dystrophic change in the tendon.

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But if they're presenting with symptoms referable to

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that area, particularly with inflammatory symptoms,

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then it could be quite clinically significant

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as in this case, and not something to completely discount.

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Now these calcifications usually are preexisting,

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so you develop some tendon injury,

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you have a calcium deposit that occurs there.

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Uh, it may per along as non-symptomatic until

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that crystal kind of bursts out

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or migrates, it becomes inflammatory and very logistic.

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And then they present with those types of symptoms.

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So when we're talking about calcific tendonitis, some

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of the most common tendons are in the shoulder,

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so often seen in the rotator cuff.

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However, the hip is not unusual, most often

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around the greater trocanter,

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but less commonly in this sub tro enteric

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region as we have in this case.

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It can occur around the elbow, wrist, knee,

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also in the hands, particularly around the

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ulnar aspect of the hand,

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Uh, with the extensor or flexor carpal narrows, tendons

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and their presentations are more

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of an inflammatory condition.

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And laboratory evaluation also typically supports that

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with elevated white count and leukocytosis

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and then increased ESR sed rate.

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Sometimes the inflammatory component is dominant

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and it may be misdiagnosed

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or the workup may pursue toward infection.

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However, these conditions do respond well

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to anti-inflammatory treatments.

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So whether it's oral nonsteroidal, anti-inflammatory agents,

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or targeted steroid injections, kind of indirect distinction

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to an infection, how do they show up?

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Well, they present as a peri articular, again, next

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to a joint, but typically not in a joint, uh,

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amorphous calcific opacity, the size

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and the shape is unrelated to the symptomatology.

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So you can have big globs of calcium that are just there

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and not necessarily symptomatic or a small focus of calcium

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because most of it might have dissolved

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or become inflammatory,

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particularly when those crystals start to migrate

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and then come out of solution.

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So in some regions of the body

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where you have a very large muscle group

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and attendant attaching to a bone, such

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as in the upper extremity pec major attachment

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to the humerus or lower extremity gluteus maximus attachment

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to the femur, you can generate erosions of the bone.

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It's typically not a usual feature,

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but it's not something that's out

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of the realm of possibility.

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And so to recap this case here, we have area

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of calcific deposit in the proximal femur.

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Cross-sectional imaging confirms

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that it's at the gluteus maximus attachment to

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that cephalic aspect of the Linea aspira

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and has some inflammatory reaction around it,

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particularly on the MRI, where we see a prominent edema

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and enhancement pattern surrounding that.

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If you look at the ct, this is more amorphous, again,

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not matrix of a neoplasm,

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but basically a focus of hydroxy appetite

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and now causing an inflammatory process.

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So in this person here

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after presentation, they were treated

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with a non-steroidal anti-inflammatories,

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and the Cal deposit resolved.