Acute Calcific Retropharyngeal Tendinitis with Eggshell-like Calcification: Case Report and Literature Review on Time-course Changes in Imaging Findings

Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review

BACKGROUND AND PURPOSE

Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited. The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition.

METHODS

This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950.

RESULTS

The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons.

CONCLUSION

A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.

Uncommon abdominal “egg-shelled” lesions mimic hepatic echinococcosis: Two cases report

Background

Primary abdominal “egg-shelled” lesions with positive anti-echinococcus IgG antibody were misdiagnosed as echinococcosis.

Case presentation

Herein we report two cases with primary abdominal “egg-shelled” lesions were misdiagnosed as echinococcosis. Case 1: A 44-year-old woman presented to our department with a history of slight abdominal pain for 4 months. After admission, the laboratory tests indicated a positive anti-echinococcus IgG antibody status. The contrast-enhanced CT scan showed a 12 × 12 cm “me contrast-mass located in the hepatorenal area. The patient had the entire mass and the right adrenal gland resected. This patient recovered smoothly and was discharged uneventfully 20 days after the operation. The pathologic diagnoses was adrenal lymphangioma. Case 2: A 55-year-old woman was admitted with a history of an abdominal mass for over 10 years. After admission, her anti-echinococcus IgG antibody was positive. The contrast-enhanced CT scan revealed a heterogeneous, solid mass measuring 10 × 9 × 8 cm in the right hepatic lobe. A laparoscopic exploration was performed, and the surgery revealed that the mass arose from the retroperitoneal tissue rather than the liver. Finally, the pathologic diagnoses were paraganglioma with necrosis and cystic changes.

Conclusion

Enhanced CT scan and contrast-enhanced ultrasound scans are important for distinguishing echinococcosis disease from the other “egg-shelled” lesions. Surgical resection is the main treatment method for this disease. Minimally invasive surgery is recommended but should be performed by experienced surgical teams. Immunohistochemical examination is important for the pathologic diagnosis.