Case 1

This is an AP radiograph of the right shoulder taken in abduction; it shows a rounded osseous density projected over the humeral head. It is well defined and would be a benign lesion if it lies within the humeral head; however, it may also be in the soft tissues around the shoulder joint. I would like to examine another view if possible, or look at cross sectional imaging for further characterisation.

This is an MRI shoulder study; it shows multiple markedly hypointense rounded foci within the teres minor tendon and muscle, corresponding to the osseous round focus on the radiograph. There is PD signal hyperintensity within the muscle surrounding the foci, indicating intra-tendinous oedema / surrounding inflammatory reaction.

These features indicate hydroxy-apatite Deposition Disease causing calcific tendonitis.

Incidentally, there is also mild thickening and hyperintensity of the supraspinatus tendon, downsloping of the acromion and a mild amount of subacromial / subdeltoid fluid- indicating mild tendinosis of the supraspinatus and mild bursitis.

I would recommend orthopaedic referral for further management.