Hydroxyapatite Deposition Disease (HADD) - MSK Radiology
Imaging Findings:
• Ovoid hypointense structures along the bursal surface of the superior cuff footprint attachment consistent with Calcium Hydroxyapatite deposits.
• Fluid-like signal seen within the deltoid muscle fibers and soft-tissues adjacent to the Calcium Hydroxyapatite deposits consistent with myositis.
• T2-hyperintense fluid-signal is seen within the subacromial/subdeltoid bursa consistent with bursitis.
Case description:
• Hydroxyapatite Deposition Disease is a broad spectrum of musculoskeletal pathology due to crystal deposition.
• This is generally monoarticular with inhomogeneous calcifications which are generally round/ovoid and faint on radiograph.
• MRI shows globular low-signal on all sequences with surrounding hyperintense signal of the soft-tissues.
- Deposits may show blooming on gradient-echo imaging with abnormal signal in the adjacent cuff.
- Limits evaluation of cuff pathology (i.e. lower specificity of tear diagnosis)
• Milwaukee shoulder:
- Generally elderly women with severe destructive arthropathy of the shoulder with hydroxyapatite deposition in the synovial fluid.
• Treatment for HADD: generally conservative. They may be needled, lavaged, and aspirated with variable results.
Differential diagnosis:
• Dystrophic calcifications from other systemic disorders: Progressive systemic sclerosis, hyperparathyroidism, etc.
• Tendinopathy or tenosynovitis: Differentiate low-signal normal tendon from globular low-signal Hydroxyapatite deposits.
Dr. Donald von Borstel @DrvonBorstel
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