2001-2002 Sandip Biswal Nancy Chege Jerry Dwek John

2001-2002  Sandip Biswal Nancy Chege Jerry Dwek John

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 Marcio Vicentini Min-Hee Lee

Rogerio Ulson Soon-Tae Kwon Jee-Young Kim Mohammed Munshi 40 year old female with pain in upper

arm 40 year old female with pain in upper arm 40 year old female with pain in upper arm 40 year old female with pain in upper arm

40 year old female with pain in upper arm 40 year old female with pain in upper arm 40 year old female with pain in upper arm Postyear Gad Axold

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

Ax T2 Diagnosis Mazabrauds Syndrome Discussion

Polyostotic fibrous dysplasia (20-30% of cases with fibrous dysplasia) More frequently involves the skull, face pelvis and shoulder girdle

Mazabrauds Syndrome (Fibrous dysplasia + intramuscular myxomas, commonly in thigh, buttock and pelvis) McCune-Albright Syndrome (Fibrous dysplasia

+ precocious puberty, cutaneous pigmentation) Mohammed Munshi 29 year old male with a seizure 29 year old male with a seizure

Non-Contrast CT 29 year old male with a seizure Post Gad Ax T1 29 year old male with a seizure

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

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

3 month Hx of enlarging lower leg mass Cor T2 Fat sat 29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Post Gad Cor T1 Fat sat

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

Extraskeletal Ewings Sarcoma (biopsy proven) with brain , chest and bone metastases Discussion

DDx of soft tissue tumors with brain mets Rhabdomyosarcoma Extraskeletal Ewings Sarcoma Alveolar Soft part Sarcoma

Viviane Khoury University 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) 60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

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

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain 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 MRI lower legs (T1 and STIR) MRI elbow and forearm (ax T1 and STIR) 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)

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 Viviane Khoury University of Montreal Montreal, Quebec, Canada

70 y.o. female Recent left ankle fracture, now c/o mild

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

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

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

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

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

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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