Transcript 30 year Reunion cases

1996-1997
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Robert R. Brown
Evelyne Fliszar
Ingrid Kjellin
Sandy Kwak
Khanh Nguyen
Thomas Rand
Joong-Mo Ahn,
Evelyne Fliszar
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47 yo female, shoulder pain post fall
47 yo female, shoulder pain post fall
Initial radiographs 9/05
47 yo female, shoulder pain post fall
6 weeks later, 11/05
47 yo female, shoulder pain post fall
Bone marrow edema
Effusion
Malalignment
High grade rotator cuff
tear
Osseous destruction
Coronal T2 w 11/05
47 yo female, shoulder pain post fall
T2 Axial FS and post IV contrast
47 yo female, shoulder pain post fall
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Joint aspiration was negative for
infection
47 yo female, shoulder pain post fall
Sagittal T2w of cervical spine, 2002
47 yo female, shoulder pain post fall
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Final
Diagnosis
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Neuropathic joint
Evelyne Fliszar
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34 yo male, hip pain following a fall
down stairs. MRI done to rule out a
fracture.
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
Axial and sagittal T2w images: edema in iliopsoas muscle
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
Axial T2w image
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
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8 weeks following trauma, repeat MRI
because of severe weakness in
quadriceps muscle.
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
Axial T2w images: muscle edema in pectineus, sartorius and quadriceps
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
8 weeks following trauma, severe weakness in quadriceps: Axial T2w FS
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
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FINAL DIAGNOSIS
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Femoral nerve injury with denervation
muscle edema
34 yo male, hip pain following a fall down stairs.
MRI done to rule out a fracture.
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Other causes of
femoral nerve
injury:
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Following iliopsoas
hematoma
Fracture of the
acetabulum
Surgery
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Ingrid Kjellin
Loma Linda University Medical Center, CA
Ingrid Kjellin
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7 year-old female with a left thigh
mass. History of cardiac
transplantation in infancy.
7 year-old female with a left thigh mass.
History of cardiac transplantation in infancy.
7 year-old female with a left thigh mass.
History of cardiac transplantation in infancy.
7 year-old female with a left thigh mass.
History of cardiac transplantation in infancy.
PET
PTLD
Post-Transplant Lymphoproliferative Disorder
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Associated with Epstein-Barr virus
infection
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Heterogeneous group of diseases after
solid organ transplant
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WHO classification:
Early (reactive plasmacytic hyperplasia)
Polymorphic PTLD
Monomorphic PTLD (lymphomas)
PTLD
Post-Transplant Lymphoproliferative Disorder
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Related to degree and duration of immunosuppression, type of
organ transplanted, CMV status
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Fever, adenopathy
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Extranodal disease in >2/3 of cases (muscle involvement
extremely rare)
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Excisional biopsy, multiple core needle biopsies, bone marrow
biopsy, CT chest/abd/pelvis
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Rx: Reduction of immunosuppression, antiviral, anti-B-lymphocyte
antibodies (rituximab), interferon, chemotherapy
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Reported rates of cure/survival variable because of heterogeneity
of disease
PTLD
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Differential: Smooth muscle
neoplasms (leiomyoma,
leiomyosarcoma) increased incidence
in immunocompromised
Ingrid Kjellin
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59 year-old male with chronic renal failure,
diabetes and hypertension. Recent left thigh
pain and swelling. Had recent abdominal
MRI/MRA
59M
59M
Discussion
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Differential diagnosis
Pyomyositis
Necrotizing fasciitis
Ischemia
Polymyositis
Scleroderma
Nephrogenic systemic sclerosis
Nephrogenic Systemic Sclerosis
(Nephrogenic Fibrosing Dermopathy)
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Rare multisystemic disorder in patients with renal insufficiency
first described in 1997 (200 cases reported to ICNFDR)
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Unknown etiology
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IV gadolinium may serve as a trigger in the setting of acute
hepatorenal syndrome or dialysis-dependent chronic renal
insufficiency
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Skin induration of extremities and trunk
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Myalgia, weakness
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Skin biopsy: proliferation of fibroblasts adjacent to collagen
bundles and absence of inflammatory cells
Nephrogenic Systemic Sclerosis
(Nephrogenic Fibrosing Dermopathy)
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Systemic fibrosis with involvement of the
skeletal muscle, bone, pleura, pericardium,
myocardium, kidney, testes, dura
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At LLUMC 12 patients 2000-2006
Skin fibrosis and joint contractures within 211 weeks following double-dose iv
gadodiamide
AJR 2007: 188, February 2007
Nephrogenic Systemic Sclerosis
(Nephrogenic Fibrosing Dermopathy)
Nephrogenic Systemic Sclerosis
Neprogenic Systemic Sclerosis
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Long term outcome: Severe inability to ambulate due to
contractures and myopathy, cane required for ambulation, no
disability. Skin changes persist.
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Plasmapheresis may have some effect. Dialysis probably of
no help.
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FDA issued a public health advisory in June 2006 with
regards to high-dose gadolinium-containing agents in patients
with renal failure
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At LLUMC: no iv gadodiamide in acute renal failure,
hepatorenal syndrome, dialysis patients or ESRD with
creatinine clearance of <15 ml/min, no double/triple dose
Neprogenic Systemic Sclerosis
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Screen patients with serum creatinine
and calculated creatinine clearance
prior to MRI with contrast if history of
kidney disease, diabetes, or >60 y.o