Transcript 2000-2001 - bonepit.com

2000-2001
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Loretta Campbell
Dillon Chen
Glenn Garcia
Herb Jones
Greg Kenyherz
Josephine Lee
Wendy McCurdy
Anthony Toppins
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Alessandro Cianfoni
Milton Miszputen
Olympia
Papakonstantinou
Russel Tucker
Nicholas Theumann
Jurea V.R. Mohana
Borges
Gonzalo Delgado
Christian Pfirrmann
Wendy McCurdy
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35 year old women
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History of right leg mass for 8 years
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Increased size of mass after bumping
it recently
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No history of surgery
35F. History of right leg mass for 8 years.
Increased size of mass after bumping it recently
T1 Axial Right Leg
35F. History of right leg mass for 8 years.
Increased size of mass after bumping it recently
T2 Axial Right Leg4
35F. History of right leg mass for 8 years.
Increased size of mass after bumping it recently
T1 Sagittal Right Leg
35F. History of right leg mass for 8 years.
Increased size of mass after bumping it recently
STIR Sagittal Right Leg
Tibialis Anterior Herniation
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Most common muscle herniation – EDL,
PB,PL, and gastrocnemius reported
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Result of local blunt trauma, penetrating
injury or muscle hypertrophy
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Complications rare – muscle necrosis
secondary to strangulation
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Fascial defect cannot always be seen on
imaging
Wendy McCurdy
16 year old girl
History-recent onset pain in the region of
the first metacarpal joint
16 year old girl. History-recent onset pain in the
region of the first metacarpal joint
CT Left hand/Thumb
16 year old girl. History-recent onset pain in the
region of the first metacarpal joint
T1 Axial Left Hand/Thumb
16 year old girl. History-recent onset pain in the
region of the first metacarpal joint
T1 Coronal Left Hand/Thumb
16 year old girl. History-recent onset pain in the
region of the first metacarpal joint
T2 FS Coronal Left Hand/Thumb
Acute Sesamoiditis of the Thumb
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In fractures ulnar sesamoid affected
3:1 to radial sesamoid
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Degenerative changes more
commonly involves the radial
sesamoid
Wendy McCurdy
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79 year old male
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History of ankle pain
79 year old male
History of ankle pain
T1 Axial Left Ankle
79 year old male
History of ankle pain
T2 FS Left Ankle
Synovial Chondromatosis
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Etiology – proliferative and metaplastic
changes in the synovium resulting in
multiple cartilaginous nodules - variable
calcification/ossification
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Presents third to fifth decades M>W
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Knee, hip and ankle joints most commonly
involved
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Treatment - surgery
References
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Clin Sports Med. 2006 Oct;25(4):803-42
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Skeletal Radiol(1999) 28:465-469.
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J Hand Surg(Am). 1985 Jan;10(1):94-100.
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J Hand Surg(Am). 1986 Mar;11(2):237-40.
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AJR 2003; 181:761-769.
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Diagnosis of Bone and Joint Disorders
Glenn Garcia
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21 y/o male tuberous sclerosis : right
knee mass.
21 y/o male tuberous sclerosis : right knee mass.
PF: Infrapatellar non-mineralized
soft tissue mass.
MR: T1, PD, Post Gd imaging show an infrapatellar lobulated low signal lesion
containing mildly enhancing septa and scattered foci of fat.
21 y/o male tuberous sclerosis : right knee mass.
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DDX:
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Localized PVNS
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Synovial hemangioma
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Tophaceous deposit
21 y/o male tuberous sclerosis : right knee mass.
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DIAGNOSIS:
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SYNOVIUM, RIGHT KNEE, EXCISION:-
BENIGN ANGIOFIBROLIPOMA
NO EVIDENCE OF MALIGNANCY
Benign Angiofibrolipoma
This lesion is most likely related to pt’s h/o TS.
The prominent expression of the fibrous
component of this lesion is represented by the
low signal on MRI. Variations of this lesion have
been well described in the kidney, heart, spleen,
lungs and GI tract of TS patients.
Glenn Garcia
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54 y/o dx’d with HIV x 3yrs with 1 mos
h/o knee pain, no h/o surgery or
trauma.
54 y/o dx’d with HIV x 3yrs with 1 mos h/o knee
pain, no h/o surgery or trauma.
Current Meds-Lopinavir, Ritonavir
54 y/o dx’d with HIV x 3yrs with 1 mos h/o knee
pain, no h/o surgery or trauma.
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Diffuse PD and T2 signal increase is
localized to the infra-patellar fat with
no other abnormality identified.
54 y/o dx’d with HIV x 3yrs with 1 mos h/o knee
pain, no h/o surgery or trauma.
Inflammation of Hoffa’s fat pad-”Hoffitis”
54 y/o dx’d with HIV x 3yrs with 1 mos h/o knee
pain, no h/o surgery or trauma.
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MR imaging findings of diffuse
inflammation of Hoffa’s fat pad are
nonspecific and unclear in etiology, an
association with HIV and/or anti-viral
meds may exist.
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Inflammation of Hoffa’s fat pad in the setting of HIV:
magnetic resonance imaging findings in six patients
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Journal Skeletal Radiology PublisherSpringer
Berlin / HeidelbergISSN0364-2348 (Print) 14322161 (Online)Subject Medicine Issue Volume 36,
Number 1 / January, 2007 CategoryScientific Article
Glenn Garcia
Incidentaloma P. quartus
Christian Pfirrmann
• Acute Severe Neck Pain
• 44 year old man
• 3 days history of
• Acute severe neck pain
• Pain on swallowing
• Markedly reduced range of motion of the neck
• DD: Inflammatory process of cervical spine (Discitis)?
Retropharyngeal abscess?
Christian W. A. Pfirrmann, Balgrist, University of Zurich, Switzerland,
Acute Severe Neck Pain
44 year old man
Acute Severe Neck Pain
44 year old man
MR: T1 & T2
Acute Severe Neck Pain
44 year old man
MR: STIR and T1 fat sat after i.v. Gad
Acute Severe Neck Pain
44 year old man
MR: T1 fat sat after i.v. Gad
Acute Severe Neck Pain
44 year old man
Radiograph and T1 fat sat after i.v. Gad
D: Calcific Retropharyngeal Tendinitis
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Acute calcific retropharyngeal tendinitis
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(Syn: Acute calcific prevertebral tendinitis)
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Foreign-body inflammatory response crystals of hydroxyapatite
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Insertion of longus colli (Anterior arch of C1)
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Symptoms: Severe neck pain, pain on swallowing, reduced
range of motion of the neck.
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Clinical presentation similar to calcific tendinitis elsewhere.
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Self-limiting, (NSAID), symptoms disappear within 1 week.
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Calcification slowly resolves after a period of 2–3 months.
Ring D, Vaccaro AR, Scuderi G, Pathria MN, Garfin SR.
Acute calcific retropharyngeal tendinitis. JBJS Am 1994;76:1636–42
Josephine Lee
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12 y boy with hand deformity
12 y boy with hand deformity
12 y boy with hand deformity
MRI
Dx: osteoenchondroma
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Characteristics of both osteochondroma and
enchondroma with cartilagenous cap and marrow
extension, but expansile tumor, scalloping,
chondroid calcifications on CT (not shown)
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Sent to Cedars-Sinai for biopsy, pathology
eventually sent to AFIP for confirmation
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Both osteochondroma and enchondroma
components
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Eventually resected due to bony deformity, no
recurrence
Josephine Lee
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65 m with neck pain, hx of prostate CA
65 m with neck pain, hx of prostate CA
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Uptake in upper Cspine
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Rest of body
nomral
65 m with neck pain, hx of prostate CA
MRI with contrast
Dx: gout
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Pannus with destruction of dens
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Initial diagnosis- RA (even with history of
prostate cancer and uptake on bone scan)
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RF negative, history of gout in foot
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Patient underwent stabilization with
hardware. Biopsy at time of surgery
demonstrate gout
Josephine Lee
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14 y male with severe right hip pain,
unusual affect and behavior
14 y male with severe right hip pain, unusual
affect and behavior
MRI
Initial working diagnosis: infection
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Patient uncooperative, difficult to examine clinically, inconsistent
history
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Elevated sed rate, HLA B-27+, no fever, intermittent back pain
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Patient underwent ultrasound guided aspiration x2
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Very little fluid aspirated
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Initial cultures- negative for bacterial, TB
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Patient referred to both pediatric orthopedics, and rheumatology
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Eventually sent to Children’s hospital
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Dx: ankylosing spondolysis
Patient continued to have disproportionate pain, despite treatment
for AS
Marked increased destruction of hip joint, femoral head,
increasing iliopsoas edema
Patient admitted at Children’s hospital with diagnosis of worsening
infection- open biopsy
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Initial results- Staph aureus. TB
cultures still negative
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Patient still does not have fevers, or
elevated WBC, mildly elevated Sed
rate
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blood cultures negative