How to diagnose bursa calcification?

Diagnosis of Bursa Calcification

Ultrasound imaging is the most effective method for diagnosing bursa calcification, as it can clearly visualize calcifications within the bursal tissue while also assessing for associated inflammation and fluid collection. 1

Imaging Modalities for Diagnosing Bursa Calcification

Ultrasound (US)

• High-frequency ultrasound (10 MHz and above) is highly sensitive for detecting calcifications within bursae 1
• Provides real-time visualization of bursal calcifications, appearing as hyperechoic areas with posterior acoustic shadowing 1
• Can simultaneously assess for associated findings such as fluid collection, synovial thickening, and hyperemia indicating inflammation 1
• Allows for dynamic assessment during movement, which can help differentiate bursal calcifications from other pathologies 1
• Particularly useful for superficial bursae such as trochanteric, prepatellar, and subacromial bursae 2, 3

Radiography

• Plain radiographs can detect larger calcifications but are less sensitive than ultrasound for smaller deposits 1
• Calcifications typically appear as rounded, amorphous opacities adjacent to bony prominences 4, 3
• Useful as an initial screening tool but may miss early or small calcifications 1
• Characteristic appearance of calcified subacromial-subdeltoid bursa can be visualized on plain films 3

CT Scan

• More sensitive than radiography for detecting calcifications but less commonly used as first-line imaging 1
• Can help determine the exact location and extent of calcifications when planning interventions 1
• Dual-energy CT can help differentiate calcium deposits from other crystal depositions 1

Anatomical Distribution and Clinical Features

• Commonly affected bursae include:

  • Trochanteric bursa (lateral hip) 2, 5
  • Prepatellar and infrapatellar bursae (knee) 4, 6
  • Subacromial-subdeltoid bursa (shoulder) 3
  • Retrocalcaneal bursa (heel) 1

• Clinical features suggestive of bursa calcification:

  • Localized pain over the affected bursa 2, 5
  • Tenderness to palpation 1, 5
  • Limited range of motion of adjacent joint 5
  • Visible or palpable swelling 4, 6
  • Pain aggravated by pressure (e.g., from shoes in retrocalcaneal bursitis) 1

Diagnostic Algorithm

1. Initial assessment:

   • Evaluate for localized pain, swelling, and tenderness over common bursal sites 1, 5
   • Assess for limited range of motion in adjacent joints 5

2. First-line imaging:

   • High-frequency ultrasound examination of the affected area 1
   • Look for hyperechoic foci with posterior acoustic shadowing within the bursa 1
   • Assess for associated fluid collection or synovial thickening 1

3. Confirmatory imaging (if needed):

   • Plain radiographs to visualize larger calcifications 1, 3
   • CT scan if more detailed assessment is required 1

4. Differential diagnosis considerations:

   • Distinguish from other calcifying conditions such as:
     • Crystal deposition diseases (gout, pseudogout) 1
     • Soft tissue sarcomas with calcification 4
     • Tendon calcifications 1

Common Pitfalls to Avoid

• Mistaking bursa calcification for a soft tissue tumor, particularly when hemorrhage is present within the bursa 4
• Failing to distinguish between tendon calcification and bursal calcification, which may require different treatment approaches 1
• Overlooking small calcifications that may be missed on plain radiographs but visible on ultrasound 1
• Confusing calcific bursitis with joint effusion or synovitis, which can have similar clinical presentations 1

By following this diagnostic approach, clinicians can accurately identify bursa calcification and distinguish it from other pathologies that may present with similar symptoms.