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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

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2001-2002

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  1. 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

  2. Mohammed Munshi • 40 year old female with pain in upper arm

  3. 40 year old female with pain in upper arm

  4. 40 year old female with pain in upper arm

  5. 40 year old female with pain in upper arm

  6. 40 year old female with pain in upper arm

  7. 40 year old female with pain in upper arm

  8. 40 year old female with pain in upper arm

  9. 40 year old female with pain in upper arm Post Gad Ax T1 fat sat

  10. 40 year old female with pain in upper arm Post Gad Ax T1 fat sat Ax T2

  11. Diagnosis • Mazabraud’s Syndrome

  12. 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)

  13. Mohammed Munshi • 29 year old male with a seizure

  14. 29 year old male with a seizure Non-Contrast CT

  15. 29 year old male with a seizure Post Gad Ax T1

  16. 29 year old male with a seizure

  17. Further History • 3 month Hx of enlarging lower leg mass

  18. 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass

  19. 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Sag T1

  20. 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Cor T2 Fat sat

  21. 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Post Gad Cor T1 Fat sat

  22. 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Post Gad Ax T1 Fat sat

  23. Diagnosis • Extraskeletal Ewing’s Sarcoma (biopsy proven) with brain , chest and bone metastases

  24. Discussion • DDx of soft tissue tumors with brain mets • Rhabdomyosarcoma • Extraskeletal Ewing’s Sarcoma • Alveolar Soft part Sarcoma

  25. 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)

  26. Bone scintigraphy (99Tc) 60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

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

  28. 60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

  29. 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

  30. MRI lower legs (T1 and STIR)

  31. MRI elbow and forearm (ax T1 and STIR)

  32. 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)

  33. 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

  34. Viviane KhouryUniversity of Montreal Montreal, Quebec, Canada • 70 y.o. female • Recent left ankle fracture, now c/o mild left knee pain

  35. 70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain Knee radiographs

  36. 70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain CT

  37. 70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain MRI (ax and sag T1)

  38. 70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain MRI (ax STIR and cor GRE)

  39. 70 y.o. female. Recent left ankle fracture, now c/o mild left knee pain MR (cor, sag, ax FS T1 post gado)

  40. 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

  41. 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

  42. 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.

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