Answer to "What would you do?"

I think there are two options. 1) Ultrasound and 2) a pneumoarthrogram with room air. Ultrasound's major drawback is limited assessment of a labral tear. A pneumoarthrogram is capable of delineating rotator cuff pathology, long head biceps tendinopathy, and labral pathology. I elected to do a pneumoarthrogram.

The top image is a paracoronal reformatted CT. The lower image is a conventional radiograph. Both are post injection of 10 cc room air. Both images reveal air in the SA-SD bursa,

Dx: Full thickness rotator cuff tear

What would you do?

Today a patient presented for CT arthrography of his shoulder. He had a truly severe contrast reaction previously and would not permit any injection of contrast. MR is not an option, as he has a cardiac pacemaker. His referring MD wants the labrum and capsular attachments assessed in addition to the usual request to assess for a rotator cuff tear. How would you proceed?

I'll show you how I approached this situation in a few days. Please share your thoughts now.