John Becker Ronald J. Boucher Ronald Chan Lisa Corrente Keir Fowler John Hopkins Kristina Kjeldsberg Emily Lee Robert Lee Kay Lozano Nataliya Plyushcheva Herman Wu. Maritza Angulo Ilma Isaza Tony Stanley Grant Brunet Edmund Tsui. 2003-2004. Kristina Kjeldsberg.
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John Becker Ronald J. Boucher Ronald Chan Lisa Corrente Keir Fowler John Hopkins Kristina Kjeldsberg Emily Lee Robert Lee Kay Lozano Nataliya Plyushcheva Herman Wu Maritza Angulo Ilma Isaza Tony Stanley Grant Brunet Edmund Tsui 2003-2004
Kristina Kjeldsberg • 62 yo active female with slowly growing mass at the plantar aspect of the right foot with discomfort.
62 yo active female with slowly growing mass at the plantar aspect of the right foot with discomfort. T1 STIR T1+C
62 yo active female with slowly growing mass at the plantar aspect of the right foot with discomfort. T1 Incidental TC coalition T1+C
Findings • 2.0x1.3x1.3 cm T2 hyperintense, avidly enhancing, well-circumscribed mass at the plantar aspect of the foot, deep to the flexor tendons between the 2nd and 3rd MT. • Appearance most consistent with a benign nerve sheath tumor. Synovial sarcoma also should be considered, however, this usually has more infiltrative margins and would be unusual in this patient’s age group.
Pathology • Benign encapsulated nerve sheath tumor, most consistent with a schwannoma.
Discussion-benign peripheral nerve sheath tumor • Schwannoma and neurofibroma. • Circumscribed fusiform mass. • May see entering/exiting nerve. • Isointense to muscle on T1. • Hyperintense on T2. Can have central low signal intensity (“target sign”) due to collagen and condensed schwann cells. • Variable enhancement. • “split fat sign”- peripheral rim of fat • Malignant degeneration very rare in schwannomas and solitary neurofibromas. 4% in NF-1.
Kristina Kjeldsberg • 43 yo female with chronic progressive right ankle pain and swelling.
Findings • Lobulated low signal intensity masses are seen extensively throughout the tibiotalar, distal tibiofibular, and subtalar joints with associated prominent osseous erosions at both sides of the joints. • Findings consistent with extensive pigmented villonodular synovitis.
Operative Report • Extensive PVNS • Treatment: anterior, posterior, and subtalar synovectomies and bone grafting of the defects in the talus and tibia.
Discussion-PVNS • Locally destructive fibrohistiocytic proliferation and villonodular protrusions of synovial membranes affecting joints, bursa, and tendon sheaths. • Lobulated masses with low signal intensity on all pulse sequences. • Subchondral erosions. • Usually monoarticular (knee 80%). • Presents with joint swelling and insidious onset of pain. Decreased range of motion.
Herman Wu • 43 year old male with lateral right ankle pain chronically.
Herman Wu • 9 year old male with left hip pain
Legg-Calve-Perthes • Case 1: Legg-Calve-Perthes; question regarding expected amount of associated bone marrow edema and synovitis.
Herman Wu • 33 year old female with knee re-injury • H/o ACL repair
Fabellar dislocation • Case 2: fabellar dislocation on MR; question regarding lack of gastrocnemius injury