Calcific tendinitis with intraosseous migration mimicking malignancy

Calcific tendinitis with intraosseous migration represents a diagnostic pitfall that frequently simulates aggressive bone neoplasms on magnetic resonance imaging (MRI), potentially triggering unnecessary oncologic workup. The authors report the case of a 26-year-old woman on immunosuppressive therapy presenting with acute, debilitating left shoulder pain. Initial MRI demonstrated a permeative-appearing process of the proximal humeral metaphysis with extensive bone marrow edema and cortical erosion, prompting a referral to orthopedic oncology. Subsequent multimodality correlation and computed tomography (CT)-guided fine-needle aspiration confirmed focal hydroxyapatite deposition without evidence of malignancy or infection. This case highlights the "edema-dominant" presentation of the resorptive phase and underscores the necessity of radiographic or CT correlation to identify MRI-occult mineralization. Recognizing enthesis-centered distribution and smooth cortical remodeling allows for confident conservative management of this self-limiting condition.