A 53-year-old female presented to the Emergency Department with the acute onset of right hip pain without a history of trauma. Examination revealed marked tenderness generalised over the right buttock.
Frog leg projection of the right hip demonstrates an area of irregular calcification at the superior aspect of the diaphysis of the right femur with amorphous calcifications in the soft tissues (Fig. 1).
Contrast enhanced CT was performed for better characterisation which revealed occult soft tissue calcification along the posterior aspect of the linea aspera of the right femur, located at the site of the gluteus maximus muscle insertion (Fig. 2). On soft tissue windows, the soft tissue calcification is again demonstrated (Fig. 3).
Calcific tendinopathy of the gluteus maximus muscle is an uncommon location for tendinopathy to occur, with only sporadic reports in the literature [1, 2].
Gluteal tendinopathy typically occurs more commonly in females than males with a mean age of approximately 60 years of age [2]. The clinical presentation is variable and can involve fever, swelling, local oedema, and pain so extreme that there is a limited range of motion [3]. Laboratory findings may include elevated levels of acute phase reactants.
Calcific tendinopathy can be categorised as acute or chronic in nature, with the acute tendinopathic process clinically lasting less than 2 weeks. The radiographic appearance may remain unchanged for many months. It is typically a self-limiting condition, although in the chronic process, the discomfort and pain has been known to last for 2 to 24 months [2, 3].
Gluteus maximus tendinopathy characteristically tends to occur at the distal tendon, and knowledge of this anatomy is important for understanding the imaging findings. The tendon inserts on along the dorsal aspect of the iliotibial band of the tensor fascia lata and also along the dorsal aspect of the femur distal to the greater trochanter at the linea aspera.
Imaging findings can include amorphous calcification and underlying osseous erosions. The differential diagnosis can include a malignant cartilaginous tumour, a malignant osseous tumour, or myositis ossificans. Knowledge of the characteristic location of this tendinopathy, as well as the clinical presentation is critical to avoid a misdiagnosis of malignancy.
The radiographic findings can suggest the correct diagnosis of gluteus maximus tendinitis when it occurs in this characteristic location and there is no underlying soft tissue mass [2, 4]. A bone scan may show localised uptake in the region of the calcification, although these characteristic radiographic findings usually make this study unnecessary [2, 4].
In summary, gluteus maximus calcific tendinopathy has a characteristic imaging appearance and location. Knowledge of the existence of this disease entity is crucial to avoid a potential misdiagnosis of malignancy.
Gluteus maximus calcific tendinopathy
Based on the provided X-ray and CT images of the right hip region, a localized dense calcification can be observed in the right gluteal area near the posterior aspect of the femur. The calcification appears as a cluster-like or irregular dense area, with no obvious soft tissue mass. On CT images, the calcification is found near the gluteus maximus tendon attachment site, close to the posterior femur or adjacent to the iliotibial band. There is no notable erosion of the local bone, no obvious soft tissue lesion, nor any visible fracture line or interruption of trabeculae. These findings suggest the calcification is primarily confined to the tendon or its attachment site.
This aligns with the imaging findings and clinical history (acute onset, female patient, severe local pain). It often presents as localized calcific deposits at the tendon insertion, accompanied by marked pain and limited mobility during the acute phase. On X-ray and CT, a localized high-density area is typically visible.
Although neoplastic processes can also present with calcification or ossification, they often show local soft tissue mass or bone destruction with certain invasive/irregular changes. In this case, there are no significant signs of malignancy on imaging, thus making this possibility less likely.
Myositis ossificans usually has a history of trauma or other provoking factors. In early stages, it may present as vague calcifications within the soft tissue, later forming a well-defined “shell” appearance. Clinically, if there is no significant history of trauma and the lesion is closer to the tendon insertion, calcific tendinopathy is more common.
Considering the patient’s age (around 50-year-old female), clinical symptoms (acute onset, severe right hip pain without trauma), imaging findings (localized calcification without soft tissue mass or notable bone erosion), and literature analysis, the most likely diagnosis is: Calcific Tendinopathy of the Gluteus Maximus.
If conservative treatment fails to improve symptoms and there is severe pain or significant functional limitation, arthroscopic or minimally invasive surgery can be considered to remove the calcific deposits. However, most cases are self-limiting and do not require surgery.
This report is based solely on the current information provided and serves only as a reference for medical analysis. It cannot replace in-person clinical evaluation or professional medical advice. If you have any concerns or if symptoms worsen, please seek medical attention or consult a specialist promptly.
Gluteus maximus calcific tendinopathy
