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2001-2002 - PowerPoint PPT Presentation


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Sandip Biswal Nancy Chege Jerry Dwek John Felt Todd Guinn Michael Huk Viviane Khoury Mohammed Munshi Steven Ross Steven Sorenson. Cagla (Chala) Tarhan Michelle Wessely Marcelo de Abreu Greg Antonio Iwan Van Breuseghem Jae-Hyun Cho Kullanut Prompitaksa Leopoldo Gigena Luis Mendes

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2001 2002
Sandip Biswal

Nancy Chege

Jerry Dwek

John Felt

Todd Guinn

Michael Huk

Viviane Khoury

Mohammed Munshi

Steven Ross

Steven Sorenson

Cagla (Chala) Tarhan

Michelle Wessely

Marcelo de Abreu

Greg Antonio

Iwan Van Breuseghem

Jae-Hyun Cho

Kullanut Prompitaksa

Leopoldo Gigena

Luis Mendes

Marcio Vicentini

Min-Hee Lee

Rogerio Ulson

Soon-Tae Kwon

Jee-Young Kim

2001-2002
mohammed munshi
Mohammed Munshi
  • 40 year old female with pain in upper arm
diagnosis
Diagnosis
  • Mazabraud’s Syndrome
discussion
Discussion
  • Polyostotic fibrous dysplasia (20-30% of cases with fibrous dysplasia)
    • More frequently involves the skull, face pelvis and shoulder girdle
  • Mazabraud’s Syndrome (Fibrous dysplasia + intramuscular myxomas, commonly in thigh, buttock and pelvis)
  • McCune-Albright Syndrome (Fibrous dysplasia + precocious puberty, cutaneous pigmentation)
mohammed munshi1
Mohammed Munshi
  • 29 year old male with a seizure
further history
Further History
  • 3 month Hx of enlarging lower leg mass
slide21

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass

Post Gad Cor T1 Fat sat

diagnosis1
Diagnosis
  • Extraskeletal Ewing’s Sarcoma (biopsy proven) with brain , chest and bone metastases
discussion1
Discussion
  • DDx of soft tissue tumors with brain mets
    • Rhabdomyosarcoma
    • Extraskeletal Ewing’s Sarcoma
    • Alveolar Soft part Sarcoma
viviane khoury university of montreal montreal quebec canada
Viviane KhouryUniversity of Montreal Montreal, Quebec, Canada
  • 60 y. o. male
  • History of recent acute pancreatitis
  • Multifocal bone pain

(case 2 – courtesy of my colleague Dr. E. Cardinal)

bone scintigraphy 99 tc
Bone scintigraphy (99Tc)

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

radiographs
Radiographs

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

60 y o male history of recent acute pancreatitis multifocal bone pain
60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain
  • At surgical exploration of forearm and tibias: “purulent material”
  • Patient is afebrile
  • Improved without antibiotics
imaging findings
Imaging Findings
  • Bone scan: Multifocal areas of uptake, diaphyseal and periarticular
  • Radiographs: osteopenia, permeative pattern of involvment in long bones and phalanges
  • MRI: Typical appearance of extensive osteonecrosis in tibias and ulnas. However, there are also areas of bony destruction (distal tibial diaphysis, ulnar shaft)
diagnosis fat necrosis 2 o pancreatic disease with medullary fat necrosis
Diagnosis: Fat Necrosis 2o pancreatic disease with medullary fat necrosis

Pancreatic disorders (ca, pancreatitis) can be complicated by following:

  • fat necrosis at multiple distant sites
  • S/c skin nodules
  • Polyarthritis
  • Medullar fat necrosis
  • Lytic bone lesions may simulate osteomyelitis (long bones, hands, feet)
  • Excess circulating lipase with autodigestion of fat deposits at distal sites?

Source: Baby Resnick, p.312

viviane khoury university of montreal montreal quebec canada1
Viviane KhouryUniversity of Montreal Montreal, Quebec, Canada
  • 70 y.o. female
  • Recent left ankle fracture, now c/o mild left knee pain
70 y o female recent left ankle fracture now c o mild left knee pain3
70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain

MRI (ax STIR and cor GRE)

70 y o female recent left ankle fracture now c o mild left knee pain4
70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain

MR (cor, sag, ax FS T1 post gado)

radiographs and ct findings
Radiographs and CT Findings
  • Exophytic, lobulated, densely ossified mass at posteromedial aspect of distal femoral diametaphysis
  • Intramedullary sclerotic foci in medial femoral condyle with spiculated margins
  • No contiguity with medullary bone
  • No aggressive features
mr findings
MR Findings
  • Exophytic ossified mass is hypointense on all sequences, as are intramedullary foci
  • Surrounding thin rim of enhancing soft tissue (of variable thickness)
  • No large soft tissue mass
diagnosis2
Diagnosis
  • Melorrheostosis (atypical, with largely mineralized exophytic component)
  • No intervention; f/u radiograph 1 year later unchanged
  • Ddx:
    • Not osteochondroma due to lack of medullary contiguity
    • Not osteosarcoma/other sarcoma due to lack of aggressive features

Judkiewicz AM, et al. Advanced imaging of melorheostosis with emphasis on MRI.

Skeletal Radiol. 2001 Aug;30(8):447-53.