We describe a 78-year-old daily hiker woman with no previous significant clinical records presented with a history of acute hip pain, limping, with no previous trauma. Clinical examination showed inability to extend lower left limb, intense pain at hip mobilization with intense limitation of hip range of motion. X-Ray showed severe coxofemoral osteoarthritis with typical CPPD calcification (Figure 1B) and radiocarpal joint calcification (Figure 1C), Ultrasonography revealed both a large hypo-echoic image located before coxofemoral joint and moderate joint synovial hypertrophy (Figure 1A); Magnetic Resonance Imaging confirmed the presence of severe iliopsoas bursitis, severe coxofemoral osteoarthritis with mild joint effusion (Figure 1D and Figure 1E). An iliopsoas bursa aspiration was performed, obtaining 15 cc of a non-inflammatory featured synovial fluid with the presence of rhomboid crystals with a weak positive birefringence at microscopy polarized light. Patient rapidly showed major improvement after ultrasonography-guided triamcinolone injection of the bursa.