The objective of this case report is to describe the importance of radiological evaluation in a case where calcium pyrophosphate deposition disease [CPPD] presented as osteoarthritis (OA). The dilemma with the overlapping presentation can be a challenging scenario to evaluate and treat. A comprehensive review of both radiographic and ultrasonographic imaging findings can be the key to connect the missing dots to address the complex clinical presentation as in the following case-report. We present a case of a 64-year-old male with symptoms of joint pain and history of being diagnosed as osteoarthritis while there was underlying CPPD, leading to perplexity and delay in diagnosis and management of CPPD.