Rice bodies in subdeltoid bursa MRI

This MRI shoulder joint shows fluid distended sub deltoid bursa with numerous typical rice bodies.

Differentials given are rheumatoid arthritis and tuberculosis.

Suggested CBC, ESR, C-reactive protein, RA, anti-CCP in view of RA and joint fluid aspiration for culture and sensitivity in view of Tubercular Arthritis.

Rice body effusion or rice bodies in joint effusion or bursa represents an uncommon, nonspecific, inflammatory process, where multiple small loose intra-articular bodies resembling polished grains of white rice. 

They are typically seen with Rheumatoid arthritis, Tuberculosis. However it is also known to occur with juvenile arthritis, seronegative arthritis, osteoarthritis, septic joint, trauma and chronic bursitis.

They are almost of same size, hypointense on T1 as well as T2 weighted images without enhancement on post contrast, the shape is very typical with tapering ends resembling rice grains.

They should be differentiated from synovial chondromatosis where loose bodies are relatively larger in size, round to ovoid in shape and impart slightly high signal on T2-weighted images.