1986-1987
description
Transcript of 1986-1987
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1986-1987• Mini Pathria
• Michael Zlatkin
• Richard (Rick) G Stiles
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Mini Pathria
• Middle-aged male
• Hx of recent knee trauma
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Case 1
• Middle-aged male• Hx of recent knee
trauma
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Radiographs
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Sagittal
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Coronal
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Axial
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Thigh
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Differential diagnosis
• Neurofibromatosis
• Melorheostosis with soft tissue component
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Neurofibromatosis
• Further history obtained
• Skin nodules• Neurofibromas on
cranial CT 7 years previously (not acoustic neuroma)
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Case 2
• Middle-aged female with thigh mass
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Radiographs
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Coronal
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MR
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Follow-up
• Mass biopsied, benign plexiform neurofibroma
• Patient developed hip pain
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Hip MR
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Neurofibromatosis
• Plexiform neurofibroma at biopsy
• No evidence of malignancy
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Case 3
• 40 year old male with slowly growing painless mass
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Plexiform neurofibroma
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Plexiform neurofibroma
• Specific finding for NF1 (peripheral form)
• 5% of patients with NF1
• Approximately 5-10% degenerate to neurosarcoma
courtesy of Mark Murphey, AFIP
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Neurofibroma
• Localized• Diffuse• Plexiform
• Well-defined• Bag of worms• Infiltrating
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Elephantiasis neurofibromatosa
• Diffuse form of plexiform neurofibroma
• Overgrowth of epidermal and subcutaneous tissue
• Wrinkled and pendulous appearance
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Michael B. Zlatkin and Alfredo Arraut NMSI
• 27 year old male involved in a motor vehicle accident
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27 year old male involved in a motor vehicle accident
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27 year old male involved in a motor vehicle accident
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Findings
• Subscapularis tendon is avulsed with bone from the lesser tuberosity
• Humeral avulsion of the anterior band of the glenohumeral ligament (HAGL)
• Middle glenohumeral ligament and possibly the superior glenohumral ligament may be avulsed as well
• Possible reverse Hill-Sachs lesion
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Subscap Rupture and HAGL (BHAGL)
• Rupture of the subscapularis tendon uncommon but can be seen in younger patients injured by forced external rotation or extension of a partially abducted arm
• Tears occur near insertion on the lesser tub. May occur at sup margin, where tendon may be weakened by degeneration
• Avulsion fracture of the lesser tuberosity may occur, and is displaced medially and inferiorly
• Subscapularis avulsions are also associated with injury to the anterior capsule and glenohumeral ligaments (HAGL)
• When the AIGHL avulses a fragment of bone from the humerus, the lesion is known as a bony HAGL, or BHAGL
• ? With MGHL and SGHL torn = Super BHAGL
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Michael B. Zlatkin and Alfredo Arraut NMSI
• 17 year old male with bony growth on the dorsum of hand
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17 year old male with bony growth on the dorsum of hand
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17 year old male with bony growth on the dorsum of hand
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Findings
• Bone prominence on the dorsum of the hand between the trapezoid, capitate, and bases of the 2nd and 3rd metacarpals
• Associated with base of 3rd metacarpal, but no marrow continuity with it
• Sclerosis and cystic change at junction with 3rd metacarpal base
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Carpal Boss
• Bone protuberance on dorsum of the hand
• Degenerative osteophyte or os styloideum
• Located between trapezoid, capitate, and base of 2nd and 3rd metacarpals
• Most often fused to a metacarpal base, but rarely (2%) can be completely isolated
• Symptoms caused by degeneration, formation of ganglion or bursa, or snapping of an extensor tendon moving over it
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Carpal Boss
• Can be demonstrated on lateral radiograph with hand flexed and supinated 30-40 degrees; best seen with mild ulnar deviation
• Alternatively can image with CT or MR
• MR can demonstrate marrow edema in the carpal boss and surrounding soft tissue changes
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Carpal Boss – Companion Case
Carpal boss fused to base of third metacarpal with edema in overlying soft tissues
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Carpal Boss - Companion Case
Carpal boss fused to third metacarpal with fracture at its base
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Carpal Boss – Companion Case
Surface rendering of carpal boss with fracture at its base
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Michael B. Zlatkin and Alfredo Arraut NMSI
• 33 year old professional hockey player with pain in the flank after practice
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33 year old professional hockey player with pain in the flank after practice
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33 year old professional hockey player with pain in the flank after practice
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Findings
• Partial thickness tear of the internal oblique muscle belly proximally, with surrounding edema and hematoma
• Fluid tracking between internal and external obliques
• Feathery pattern of edema at the more distal aspect of the internal oblique
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Side Strain
• Uncommon sporting injury presenting with pain and tenderness over anterolateral and posterolateral lower ribcage
• Associated with cricket, golf, and ice hockey – eccentric contraction of trunk muscles
• Partial or complete tear of lateral abdominal wall musculature (internal oblique > external oblique > transversus abdominis)
• May also see avulsion at the muscular origins from the lower ribs
• Recovery takes 6-10 weeks. Full recovery is the norm