46-year-old patient presenting with severe shoulder pain and significant functional limitation. Symptoms are acute or subacute with high pain intensity.
Ultrasound examination of the shoulder demonstrates a very large calcific deposit within the subacromial-subdeltoid (SASD) bursa, consistent with calcific bursitis.
The calcification is classified as type 3 (soft/resorptive phase) and measures approximately 24.3 × 17.2 × 6.5 mm. It is located at the transition between the supraspinatus and infraspinatus tendons, positioned on and lateral to the greater tuberosity (tuberculum majus).
There is marked distension of the SASD bursa, with pronounced neovascularization and likely associated neoinnervation, indicating an active inflammatory and highly symptomatic phase.
No additional structural details are provided.
1. Final diagnosis
Severe calcific subacromial-subdeltoid bursitis in the resorptive phase, with a large type 3 calcific deposit and marked neovascularization.
2. Differential diagnosis
Consider septic bursitis in the presence of systemic or local inflammatory signs, although current findings are more consistent with inflammatory calcific bursitis.
3. Teaching points
Type 3 (soft) calcifications are typically seen in the resorptive phase and are often highly symptomatic. Marked neovascularization correlates with active inflammation and pain. Large calcific deposits can extend into the bursa and cause significant functional limitation.
4. Injury/disease information
Calcific tendinopathy can progress into the resorptive phase, during which calcium deposits become softer and may migrate into the bursa, triggering intense inflammatory reactions. This phase is often associated with severe pain but may precede spontaneous resolution.
5. Clinical recommendation:
Given the severity of symptoms and functional limitation, the patient is advised to contact their general practitioner for further management.
The patient should be instructed to seek urgent medical attention in case of red flag symptoms such as fever, general malaise, redness of the shoulder, or increased warmth, as these may indicate septic bursitis, although there are currently no clear signs of this.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at EchoConsult in Roermond, the Netherlands.
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