12 interesting msk cases
TRANSCRIPT
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12 Interesting
MSK Cases
James F Griffith
Department of Imaging and Interventional Radiology
Prince of Wales Hospital
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Case 1: 12-year-old boy
Slipped and fell. Anterior knee pain and swelling
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Knee pain
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Knee pain
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Knee pain
Periosteal sleeve avulsion : adolescence
Forced quadriceps contraction
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Periosteal sleeve avulsion
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Case 2: 45-year-old man
Multiple joint pains x 3yr
Wrist, shoulder, knee, ankle
RA negative
HLA B27 neg
↑ CRP
↑ ESR
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Joint pains
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Joint pains
Currently treated as either peripheral SpA or seronegative RA
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Case # 3: 37-year-old man
Psoriasis
Multiple joint pains
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Knee pain
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Case 4: 44-year-old female
RA. Shoulder pain and swelling for 2 months
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Shoulder swelling
Rice bodies : hypointense on T1- and T2WI
Chondroid bodies: hyperintense on T2WI
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Case #5: 31-year old man
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Case #5: 31-year old man
Adductor tendon tear, ‘sports hernia’
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Case #5: 31-year old man
Adductor tendon tear, ‘sports hernia’
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Case #6: 62-year-old man
LEFT SIDE TSRIGHT SIDE TS
Ca Pancreas 2017. Proximal thigh mass x 2 months, ? lipoma
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Hypertrophy tensor fascia lata
LEFT SIDE LS
RIGHT SIDE LS
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Previous CT
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Case #7: 67-year-old man
Nasopharnygeal
carcinoma Rxd with
radiotherapy 1986
Supraclavicular mass
X 2 months
Came on after push-
ups. Static since then.
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Clavicular mass
2010
2017
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Ultrasound
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CT
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PET CT
SUVmax 3.3
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Diagnosis
Biopsy
• Fibrosis and necrotic bone fragments
• Reactive granulation tissue
• No granuloma. No malignancy.
Gram stain, TB, fungal culture: -ve
Exuberant callus formation secondary to
radiation-induced insufficiency fracture of the
clavicle
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Case # 8: 17-year-old girl
First presented aged 17
Bilateral UL (>left) + LEFT LL weakness x one year
LUL first, then R UL, then L LL
Wasting, weakness and hyperreflexia
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Case #8:
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2012
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2012
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2012
Neutral Flexed
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Latest FU, June 2017
LUL function same
Progressive RUL weakness & numbness
Lower limbs similar
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Follow-up MRI
20122017 2017
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Hirayama’s Disease
Sporadic, > adolescent males, insidious
> Asian countries
Muscle atrophy hand > forearm flexor,
branchioradialis typically preserved
Finger tremor and cold paresis
Sensory symptoms less
Progression stops after 2-3 years in most
patients and before 5 years in 75%
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Proposed Mechanisms
Cervical spinal cord compressed by anterior shift
of the posterior dura during neck flexion leading to
ischemic necrosis of cord (esp. anterior horns)
“Cervical Flexion Myelopathy” (CFM)
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MRI Features
Normal + cord atrophy in neutral position
Anterior shift of the posterior dura mater during
flexion with flattening of the spinal cord against
mid-cervical vertebral bodies
Contrast enhancement of crescent-shaped
posterior cervical epidural space
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Treatment
Conservative : Neck collar
Arthrodesis (Anterior or Posterior) + Duraplasty
Duraplasty alone
Laminoplasty + Duraplasty
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Case # 9: 37-year-old man
Chronic disease
Enlarging mass foot x 2 yesrs, ? malignancy
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Radiographs
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Ultrasound
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CT
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CT
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Case # 10: 35-year-old female
Left lower quadrant pain x 2 months
CS for IUD 2010 in Philippines
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CT
? infection in scar, ? sarcoma
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Ultrasound
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Ultrasound
Endometriosis
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Case #11: 70-year-old female
Umbilical mass x 1 month
CT (private): large pelvic mass,
most likely ovarian and
umbilical mass Bx: poorly differentiated
carcinoma
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Case #11: 52-year-old female
Infarcted infected mesenteric fat confirmed at surgery
Grew staph.
TAHBSO St Theresa in 2012.
Umbilical pain and tenderness x 2 weeks
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Case #12: 52-year-old female
Enlarging thigh mass x 10 years
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CT
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Biopsy
Osteoid and chondroid elements, no suspicious features :
‘osteochondroma of soft parts’
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Post-op
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Thank you