Transcript 30 year Reunion cases

1986-1987
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Mini Pathria
Michael Zlatkin
Richard (Rick) G Stiles
Mini Pathria
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Middle-aged male
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Hx of recent knee trauma
Case 1
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Middle-aged male
Hx of recent knee
trauma
Radiographs
Sagittal
Coronal
Axial
Thigh
Differential diagnosis
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Neurofibromatosis
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Melorheostosis
with soft tissue
component
Neurofibromatosis
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Further history
obtained
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Skin nodules
Neurofibromas on
cranial CT 7 years
previously (not
acoustic neuroma)
Case 2
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Middle-aged
female with thigh
mass
Radiographs
Coronal
MR
Follow-up
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Mass biopsied,
benign plexiform
neurofibroma
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Patient developed
hip pain
Hip MR
Neurofibromatosis
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Plexiform
neurofibroma
at biopsy
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No evidence
of
malignancy
Case 3
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40 year old
male with
slowly
growing
painless
mass
Plexiform neurofibroma
Plexiform neurofibroma
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Specific finding for
NF1 (peripheral
form)
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5% of patients with
NF1
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Approximately 510% degenerate to
neurosarcoma
courtesy of Mark Murphey, AFIP
Neurofibroma
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Localized
Diffuse
Plexiform
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Well-defined
Bag of worms
Infiltrating
Elephantiasis neurofibromatosa
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Diffuse form of plexiform
neurofibroma
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Overgrowth of epidermal
and subcutaneous tissue
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Wrinkled and pendulous
appearance
Michael B. Zlatkin and Alfredo Arraut
NMSI
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27 year old male involved in a motor
vehicle accident
27 year old male involved in a motor vehicle
accident
27 year old male involved in a motor vehicle
accident
Findings
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Subscapularis tendon is avulsed with bone
from the lesser tuberosity
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Humeral avulsion of the anterior band of the
glenohumeral ligament (HAGL)
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Middle glenohumeral ligament and possibly the
superior glenohumral ligament may be avulsed
as well
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Possible reverse Hill-Sachs lesion
Subscap Rupture and HAGL (BHAGL)
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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
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Tears occur near insertion on the lesser tub. May occur at sup
margin, where tendon may be weakened by degeneration
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Avulsion fracture of the lesser tuberosity may occur, and is
displaced medially and inferiorly
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Subscapularis avulsions are also associated with injury to the
anterior capsule and glenohumeral ligaments (HAGL)
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When the AIGHL avulses a fragment of bone from the humerus,
the lesion is known as a bony HAGL, or BHAGL
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? With MGHL and SGHL torn = Super BHAGL
Michael B. Zlatkin and Alfredo Arraut
NMSI
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17 year old male with bony growth on
the dorsum of hand
17 year old male with bony growth on the dorsum
of hand
17 year old male with bony growth on the dorsum
of hand
Findings
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Bone prominence on the dorsum of the
hand between the trapezoid, capitate, and
bases of the 2nd and 3rd metacarpals
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Associated with base of 3rd metacarpal, but
no marrow continuity with it
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Sclerosis and cystic change at junction with
3rd metacarpal base
Carpal Boss
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Bone protuberance on dorsum of the hand
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Degenerative osteophyte or os styloideum
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Located between trapezoid, capitate, and
base of 2nd and 3rd metacarpals
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Most often fused to a metacarpal base, but
rarely (2%) can be completely isolated
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Symptoms
caused
by
degeneration,
formation of ganglion or bursa, or snapping of
an extensor tendon moving over it
Carpal Boss
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Can be demonstrated on lateral radiograph
with hand flexed and supinated 30-40
degrees; best seen with mild ulnar deviation
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Alternatively can image with CT or MR
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MR can demonstrate marrow edema in the
carpal boss and surrounding soft tissue
changes
Carpal Boss – Companion Case
Carpal boss fused to base of third metacarpal with edema in overlying soft tissues
Carpal Boss - Companion Case
Carpal boss fused to third metacarpal with fracture at its base
Carpal Boss – Companion Case
Surface rendering of carpal boss with fracture at its base
Michael B. Zlatkin and Alfredo Arraut
NMSI
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33 year old professional hockey player
with pain in the flank after practice
33 year old professional hockey player with pain
in the flank after practice
33 year old professional hockey player with pain
in the flank after practice
Findings
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Partial thickness tear of the internal
oblique muscle belly proximally, with
surrounding edema and hematoma
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Fluid tracking between internal and
external obliques
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Feathery pattern of edema at the more
distal aspect of the internal oblique
Side Strain
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Uncommon sporting injury presenting with pain and
tenderness over anterolateral and posterolateral lower
ribcage
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Associated with cricket, golf, and ice hockey – eccentric
contraction of trunk muscles
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Partial or complete tear of lateral abdominal wall
musculature (internal oblique > external oblique >
transversus abdominis)
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May also see avulsion at the muscular origins from the
lower ribs
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Recovery takes 6-10 weeks. Full recovery is the norm