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Type:
Educational Exhibit
Keywords:
Education and training, Diagnostic procedure, MR, Musculoskeletal soft tissue
Authors:
J. J. Chen, P. Yoong, E. McNally; Oxford/UK
DOI:
10.1594/ecr2014/C-1597
Findings and procedure details
We present a pictorial review of the MRI findings in three symptomatic cases of gluteus maximus enthesopathy.
Patient 1. 70 year old woman with a 10 month history of left thigh pain (Fig.
6).
MRI demonstrated thickening of the gluteus maximus tendon insertion on the posterior femur with a prominent bony spur.
There was no associated calcification or oedema.
There was also no significant degenerative change in the left hip joint nor inflammation of the other gluteal insertions on the greater trochanter.
The pain resolved after conservative treatment with physiotherapy.
Patient 2. 81 year old woman with a 6 month history of left thigh pain (Figs.
7,
8)
Plain radiography showed a lucent lesion in the left proximal femur.
This was initially thought to represent a metastasis or myeloma.
However,
body CT and myeloma screening were negative for these conditions.
Subsequent MRI showed inflammation of the gluteus maximus tendon with a cortical cyst at its insertion onto the posterior femur,
accounting for the plain film findings. There was no significant degenerative change in the left hip joint nor inflammation of the other gluteal insertions on the greater trochanter.
No follow-up was available at the time of writing.
Patient 3. 73 year old woman with a 12 month history of left buttock pain (Figs.
9,10).
Plain radiography showed a calcific focus related to the proximal femur,
initially thought to represent a chondroid lesion.
A subsequent MRI was performed for further investigation.
This showed a thickened and inflammed gluteus maximus tendon with a calcific focus within it,
accounting for the plain film findings. There was no significant degenerative change in the left hip joint nor inflammation of the other gluteal insertions on the greater trochanter.
No follow-up was available at the time of writing.
Summary
- Radiological findings in gluteus maximus enthesopathy are similar to those seen in other locations in the body,
although the location is relatively unusual
- Plain radiography can demonstrate both lucency and calcification related to the proximal femur which may be confused for sinister pathology
- MRI may show thickening of the gluteus maximus tendon,
oedema within the tendon and surrounding soft tissues,
as well as calcification and cortical cysts
- With positive findings on MRI,
a relevant clinical history and the absence of other significant local pathology,
gluteus maximus enthesopathy should be considered as a possible cause of thigh/buttock symptoms.