Case of the Month

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Submitted by Ricky Kaneshiro, MD and Thomas Learch, MD

Presentation

30-year-old female with PMH of hyperparathyroidism presents to the ED with right knee pain after mechanical fall.

Imaging

Knee x ray was done which showed no fractures or soft tissue swelling. There was, however, thickening of the patellar and quadriceps tendons with suggestion of intra-tendinous dystrophic calcifications.

MRI was performed and re-demonstrated thickening of the patellar and quadriceps tendons with focal calcifications within the proximal patellar tendon.

Discussion

Parathyroid hormone (PTH) is produced by the parathyroid glands and helps to maintain serum calcium levels. When calcium levels are low PTH is secreted. Osteoclast activity is increased which in turn leads to bone resorption and release of calcium. Hyperparathryoidism is a condition of excess parathyroid hormone and is classified as either primary, secondary or tertiary. Excess PTH can lead to intra-tendinous dystrophic calcifications and subperiosteal bone resorption which ultimately results in tendinopathy with increased risk of rupture.

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