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1
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Versiani Caldeira Gonçalves D, Azevedo Nicodemos da Cruz I, Astolfi Caetano Nico M, Gomes Ormond Filho A, Brandão Guimarães J. Reviewing superficial bone lesions: What the radiologist needs to know. Clin Imaging 2025; 123:110493. [PMID: 40378638 DOI: 10.1016/j.clinimag.2025.110493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 05/02/2025] [Accepted: 05/05/2025] [Indexed: 05/19/2025]
Abstract
Superficial bone lesions arise from the outer components of the bone, from the cortex to the periosteum. Such superficial lesions are often challenges during imaging reporting, and their incorrect interpretation may lead to inadequate management. We present a literature review regarding these lesions according to a standardized division into tumoral and non-tumoral lesions. We also provide a guide for their proper assessment on different imaging modalities. Knowledge of the specific imaging features that aid in the determination of the lesion origin and estimation of the risk of malignancy is fundamental for the radiologist to contribute to adequate patient management.
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Affiliation(s)
- Dâmaris Versiani Caldeira Gonçalves
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso, 306, Lj 01. Higienópolis, São Paulo/SP, 01239-040, Brazil.
| | - Isabela Azevedo Nicodemos da Cruz
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso, 306, Lj 01. Higienópolis, São Paulo/SP, 01239-040, Brazil.
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso, 306, Lj 01. Higienópolis, São Paulo/SP, 01239-040, Brazil.
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso, 306, Lj 01. Higienópolis, São Paulo/SP, 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso, 306, Lj 01. Higienópolis, São Paulo/SP, 01239-040, Brazil; Department of Radiology and Biomedical Imaging, University of California, 1701 Divisadero St, CA 94115, San Francisco, USA.
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2
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Akurathi HK, Ronanki V, Korrapati RK, Rami Reddy M. Neglected Elbow Injury With Severe Flexion Deformity With Myositis Ossificans. Cureus 2025; 17:e81171. [PMID: 40276435 PMCID: PMC12021008 DOI: 10.7759/cureus.81171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2025] [Indexed: 04/26/2025] Open
Abstract
Myositis ossificans is a rare entity of extra-skeletal bone formation in various soft tissues and muscles, often triggered by trauma or injury. We report a case of myositis ossificans traumatica in a 45-year-old female who presented with pain and a fixed flexion deformity of the elbow. Imaging studies, including X-ray and magnetic resonance imaging (MRI), revealed a bony mass in the posterior aspect of the right elbow and presence of triceps injury. The patient underwent surgical excision with arthrolysis. To prevent further heterotopic bone formation, excessive massaging or rubbing of the affected area was avoided. The postoperative period was uneventful.
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Affiliation(s)
| | - Varun Ronanki
- Pathology, NRI Medical College Chinakakani, Guntur, IND
| | | | - Mettu Rami Reddy
- Orthopaedics, NRI Medical College and General Hospital Chinakakani, Guntur, IND
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3
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Molla NW. Subcutaneous anterior abdominal wall myositis ossificans. Radiol Case Rep 2025; 20:196-200. [PMID: 39502280 PMCID: PMC11535982 DOI: 10.1016/j.radcr.2024.09.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 11/08/2024] Open
Abstract
The differential diagnosis of abdominal wall lesions is broad and includes Myositis ossificans (MO). MO primarily arises in skeletal muscles, but can also occur around adjacent structures. It typically appears as a soft tissue lesion with peripheral rim of calcification. The Presented case is of 21-year-old woman with a right lower quadrant mass without a history of trauma but with a positive history of excessive exercise. Radiological images were nonspecific, and tissue biopsy showed features consistent with myositis ossificans. Follow up images revealed findings consistent with the histopathological diagnosis. This case highlights the nonspecific Imaging findings of MO in the early stages and that MO early stage can be prolonged.
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4
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Faraj C, Essetti S, El Harras Y, Lrhorfi N, Mrani Alaoui N, Dendane MA, Amrani A, El Fellous El Alami SZ, El Madhi T, Allali N, El Haddad S, Chat L. Myositis ossificans circumscripta of the thigh: A pediatric case report. Radiol Case Rep 2024; 19:6547-6554. [PMID: 39391031 PMCID: PMC11465076 DOI: 10.1016/j.radcr.2024.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 10/12/2024] Open
Abstract
Circumscribed myositis ossificans is a benign process of focal heterotopic ossification of the soft tissues, occurring in young subjects, usually following trauma. We report a case of a 15-year-old patient who suffered a direct trauma to the thigh during a soccer match, and developed a hard mass in the anterior face of the thigh. The patient was diagnosed with myositis ossificans secondary to trauma. In this case report, we want to illustrate the different imaging aspects of this benign condition, both in conventional radiology, computed tomography and magnetic resonance imaging, as its clinical and radiological appearance can be misleading, suggesting a sarcomatous neoplastic process.
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Affiliation(s)
- Chaymae Faraj
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Sara Essetti
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yahya El Harras
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Najlae Lrhorfi
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nidal Mrani Alaoui
- Pediatric surgery department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Anouar Dendane
- Pediatric surgery department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelouahed Amrani
- Pediatric surgery department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | | | - Tarik El Madhi
- Pediatric surgery department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Children's Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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5
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Cunningham CR, Mehrsheikh AL, Aswani Y, Shetty AS, Itani M, Ballard DH, Khot R, Moshiri M, Picard MM, Northrup BE. Off the wall: incidental paraspinal and pelvic muscle pathology on abdominopelvic imaging. Abdom Radiol (NY) 2024; 49:4016-4041. [PMID: 38831073 DOI: 10.1007/s00261-024-04365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024]
Abstract
As the use of cross-sectional abdominal and pelvic imaging has increased exponentially in the past several decades, incidental musculoskeletal findings have become commonplace. These are often unrelated to the indication for the examination and are frequently referred to as the "radiologist's blind spot" on these studies. The differential diagnosis for abnormalities of the paraspinal and pelvic musculature is, in many cases, quite different from the anterior abdominal wall muscles. Furthermore, due to their relatively deep location, pathology involving the former muscle groups is more likely to be clinically occult, often presenting only incidentally when the patient undergoes cross-sectional imaging. Effective treatment of diseases of these muscles is dependent on adherence to a diverse set of diagnostic and treatment algorithms. The purpose of this review article is to familiarize the radiologist with the unique pathology of these often-overlooked muscles of the abdomen and pelvis.
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Affiliation(s)
- Christopher R Cunningham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Amanda L Mehrsheikh
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Yashant Aswani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Mariam Moshiri
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Melissa M Picard
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin E Northrup
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA.
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6
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Maruszczak K, Kochman M, Madej T, Gawda P. Ultrasound Imaging in Diagnosis and Management of Lower Limb Injuries: A Comprehensive Review. Med Sci Monit 2024; 30:e945413. [PMID: 39223775 PMCID: PMC11378687 DOI: 10.12659/msm.945413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Medical imaging tests are widely used to diagnose a broad spectrum of lower-limb injuries. Among these modalities, ultrasound (US) imaging has gained significant traction as a valuable diagnostic instrument for assessing conditions primarily affecting muscles, tendons, ligaments, and other soft tissues. However, there are important dilemmas related to the indications and possibilities of US in lower-limb injuries. Conflicting findings and approaches raise questions regarding the validity, accuracy, and usefulness of the US in that area. This narrative review attempts to summarize the current state of knowledge regarding US imaging of lower-limb injuries. The study provides a detailed discussion of the existing literature and contemporary insights on the diagnosis of lower-limb injuries using US examination, and draws attention to the role of the US in interventional procedures and monitoring of the healing process. The characteristics of normal muscles, tendons, and ligaments in US imaging are presented, along with the most commonly documented conditions affecting these tissues. Furthermore, the benefits and justifications for employing US in interventional procedures are discussed, ranging from platelet-rich plasma injections to physiotherapeutic treatments like percutaneous electrolysis. The study was further augmented with US pictures depicting various lower-limb injuries, mainly affecting young athletes. This article aims to review the role of US imaging in the diagnosis and management of common lower-limb injuries.
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Affiliation(s)
- Krystian Maruszczak
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Maciej Kochman
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Tomasz Madej
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, Lublin, Poland
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7
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Ji T, Zhang G, Zhang J, Li Y, Zhang X, Liu Q, Sun N, Liu Z, Li X, Liu Y, Wang S, Ni X. Myositis Ossificans of the Trapezius Muscle: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2024; 103:NP520-NP526. [PMID: 37226767 DOI: 10.1177/01455613231175316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Myositis ossificans (MO) is a benign, self-limiting, and nonneoplastic lesion involving the skeletal muscle or soft tissue, rarely occurring in the head and neck. It is relatively rare in clinical practice, and it is difficult to distinguish specific cases from musculoskeletal conditions, which poses unique challenges for clinical diagnosis and treatment. We reported that a 9-year-old boy suffered from local and nontraumatic MO of the trapezius muscle. Given the rarity of this case, the present article detailed the diagnosis and treatment of this rare case and reviewed the relevant literature on MO, focusing on the clinical, pathological, and radiographic characteristics of MO. Notably, these investigations aimed to enhance clinicians' understanding of the disease and improve diagnostic accuracy.
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Affiliation(s)
- Tingting Ji
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ge Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yanzhen Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xuexi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Qiaoyin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Nian Sun
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Zhiyong Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yuwei Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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8
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Gonçalves DVC, da Silva LNM, Guimarães JB, da Cruz IAN, Filho AGO. Imaging spectrum of atraumatic muscle disorders: a radiologist's guide. Skeletal Radiol 2024; 53:1449-1464. [PMID: 38520541 DOI: 10.1007/s00256-024-04659-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
Atraumatic muscle disorders comprise a very wide range of skeletal muscle diseases, including metabolic, inflammatory, autoimmune, infectious, ischemic, and neoplastic involvement of the muscles. Therefore, one must take clinical and laboratory data into consideration to elucidate the differential diagnoses, as well as the distribution of the muscle compromise along the body-whether isolated or distributed along the body in a symmetric or asymmetrical fashion. Assessment of muscular disorders often requires imaging investigation before image-guided biopsy or more invasive procedures; therefore, radiologists should understand the advantages and limitations of imaging methods for proper lesion evaluation and be aware of the imaging features of such disorders, thus contributing to proper decision-making and good patient outcomes. In this review, we propose a systematic approach for the assessment of muscle disorders based on their main imaging presentation, dividing them into patterns that can be easily recognized.
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Affiliation(s)
| | - Lucas N M da Silva
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
| | | | - Isabela A N da Cruz
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil
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9
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Werenski JO, Hung YP, Chang CY, Nielsen GP, Lozano-Calderón SA. Myositis ossificans mimicking bone surface osteosarcoma: case report with literature review. APMIS 2024; 132:535-543. [PMID: 38741286 DOI: 10.1111/apm.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Myositis ossificans, a benign tumor composed of spindle cells and osteoblasts, can clinically and radiologically mimic osteosarcoma. While recognition and accurate diagnosis of myositis ossificans can be a challenge, this is critical as it may allow a conservative surgical approach to maximize functional outcomes. Herein, we present a patient with surface myositis ossificans confirmed genetically by the presence of COL1A1::USP6 gene fusion, along with a literature review. Due to the enhanced visualization of the bone matrix, computed tomography (CT) imaging may be a superior imaging modality to magnetic resonance (MR) imaging. Staged biopsies with samples obtained from the periphery and center of the lesions may allow pathologists to discern the zonal distribution histologically. Furthermore, immunohistochemistry fluorescence in situ hybridization and molecular testing can aid in the distinction of myositis ossificans from mimics. Because of their resemblance to other bone tumors, these cases of myositis ossificans highlight the importance of a multidisciplinary approach integrating clinical, radiologic, and pathologic analysis and involving serial imaging, sampling, and judicious use of ancillary immunohistochemical and molecular testing.
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Affiliation(s)
- Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging & Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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Makkawi S, Khojah O, Abualnaja R, Qashqari A, Alahmadi NA, Bshnaq AG, Alharthi A, Al-Hashemi HH, Shawli AM. Fibrodysplasia Ossificans Progressiva Mimics Generalized Dystonia Disorder: A Case Report. Cureus 2023; 15:e50769. [PMID: 38269236 PMCID: PMC10806276 DOI: 10.7759/cureus.50769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant disorder characterized by congenital deformities of the big toes and the progressive formation of extra-skeletal bone within soft tissues. The underlying genetic cause of FOP is mostly due to gain-of-function mutations in the AVCR1/ALK2 genes. These mutations cause aberrant bone morphogenetic protein (BMP) signaling pathways and eventually result in cumulative musculoskeletal impairment. FOP has a prevalence of approximately one in every 2 million people worldwide, with nearly 90% of patients being misdiagnosed, possibly leading to an underestimation of its true prevalence. To the best of our knowledge, there are only three reported cases in Saudi Arabia. We report a case of a 21-year-old female patient, a product of a consanguineous marriage, referred to the neurology clinic for new-onset dysphagia and dysarthria in association with progressive painful muscle stiffness, which started at the age of four years. The diagnosis of generalized dystonia disorder was suspected, but eventually the whole exome sequencing showed a pathogenic missense mutation in the ACVR1 gene, confirming the diagnosis of FOP. FOP is a rare, debilitating disorder that can be difficult to diagnose and manage. Current research efforts are focused on early diagnosis and a high index of suspicion to help prevent unnecessary investigations and procedures, slow the progression of the disease, and promote patients' quality of life and long-term outcomes.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Osama Khojah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
| | - Reema Abualnaja
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulaziz Qashqari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Nawaf A Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdullatif G Bshnaq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulrahman Alharthi
- Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hashem H Al-Hashemi
- Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Aiman M Shawli
- Genetics and Precision Medicine, Ministry of the National Guard-Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
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11
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Abou Shaar B, El-Karim GA, Alsaied AR, Almalki N, Ashraf N, Almalki A, Duggal R, Munir S. Beyond the bones: Extraskeletal osteosarcoma of the thigh. Radiol Case Rep 2023; 18:2126-2135. [PMID: 37089974 PMCID: PMC10113790 DOI: 10.1016/j.radcr.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
Extraskeletal osteosarcoma (ESOS) is a rare malignant mesenchymal soft tissue tumor that usually arises in the lower extremities. It is typically a high-grade malignancy that represents only around 1%-2% of all soft tissue sarcomas and 2%-4% of all osteosarcomas. In this report, we describe a case of a 67-year-old female who presented with a 4-day history of a painless lump in her posterior right thigh. Workup utilizing different imaging modalities yielded a diagnosis of ESOS. The radiologic features of ESOS, as well as the current treatment paradigm and prognosis of this rare malignancy, will be discussed based on a review of the literature.
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Affiliation(s)
- Bader Abou Shaar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Diagnostic Imaging, Bluewater Health, Sarnia, ON, Canada
- Department of Medical Imaging, Juravinski Hospital, Hamilton, ON, Canada
| | | | | | - Nadeem Almalki
- Faculty of Math, University of Waterloo, Waterloo, ON, Canada
| | - Nader Ashraf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ameera Almalki
- Department of Diagnostic Imaging, Bluewater Health, Sarnia, ON, Canada
| | - Rishi Duggal
- Department of Diagnostic Imaging, Bluewater Health, Sarnia, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Sohaib Munir
- Department of Medical Imaging, Juravinski Hospital, Hamilton, ON, Canada
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12
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Broski SM, Wenger DE. Multimodality imaging features of USP6-associated neoplasms. Skeletal Radiol 2023; 52:297-313. [PMID: 35962835 DOI: 10.1007/s00256-022-04146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Since the discovery of USP6 gene rearrangements in aneurysmal bone cysts nearly 20 years ago, we have come to recognize that there is a family of USP6-driven mesenchymal neoplasms with overlapping clinical, morphologic, and imaging features. This family of neoplasms now includes myositis ossificans, aneurysmal bone cyst, nodular fasciitis, fibroma of tendon sheath, fibro-osseous pseudotumor of digits, and their associated variants. While generally benign and in many cases self-limiting, these lesions may undergo rapid growth, and be confused with malignant bone and soft tissue lesions, both clinically and on imaging. The purpose of this article is to review the imaging characteristics of the spectrum of USP6-driven neoplasms, highlight key features that allow distinction from malignant bone or soft tissue lesions, and discuss the role of imaging and molecular analysis in diagnosis.
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Affiliation(s)
- Stephen M Broski
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA.
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Charlton Building North, 1st Floor, 200 First Street SW , Rochester, MN, 55905, USA
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13
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Sapire R, Nenova R, Gounder P, Rampersad A, Maboho V, Nhlapo N, Tibatshi K, Rampurtab S, Ranchod AI, Saggers RT, Patricios J. Myositis ossificans in a child athlete: a case study. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2023; 34:v34i1a14931. [PMID: 36815913 PMCID: PMC9924576 DOI: 10.17159/2078-516x/2022/v34i1a14931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background A 13-year-old female athlete presented with a painful lesion in her right buttock for which she had been receiving physiotherapy. It was keeping her from participating in sports. Aim To report on a case of traumatic myositis ossificans in a child athlete - including the presentation, investigations, management, and outcome. Findings Palpation of the right buttock indicated a tender mass. Investigation by musculoskeletal ultrasound detected a large hypoechoic lesion. An MRI revealed patterns of calcification that were inconclusive in differentiating between a malignant or benign lesion. Macroscopic and microscopic histological examination, as well as immunohistochemistry, were consistent with myositis ossificans (MO), a non-malignant condition. The patient improved remarkably within three months of treatment with rest, non-steroidal anti-inflammatory drugs (NSAIDs) and extracorporeal shock wave therapy (ESWT). Implications Accurate differentiation of myositis ossificans from other benign and malignant soft tissue lesions may require histological evaluation in addition to a comprehensive radiological workup. Successful treatment with the patient being able to return to a pain-free and active state is achievable. Extracorporeal shock-wave therapy can play an important role in the management of this condition and should be considered when presented with a case of MO.
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Affiliation(s)
- R Sapire
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - R Nenova
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - P Gounder
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - A Rampersad
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - V Maboho
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - N Nhlapo
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - K Tibatshi
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - S Rampurtab
- Unit for Undergraduate Medical Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - AI Ranchod
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg,
South Africa
| | - RT Saggers
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - J Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa,Netcare Waterfall Sports Orthopaedic Surgery, Johannesburg,
South Africa
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14
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Salastekar N, Su A, Rowe JS, Somasundaram A, Wong PK, Hanna TN. Imaging of Soft Tissue Infections. Radiol Clin North Am 2023; 61:151-166. [DOI: 10.1016/j.rcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Silveri C, Stoppiello P, Gaiero L, Bianchi G, Casales N, Belzarena AC. Aggressive atraumatic myositis ossificans in a toddler. Radiol Case Rep 2022; 17:4550-4555. [PMID: 36193266 PMCID: PMC9526017 DOI: 10.1016/j.radcr.2022.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/25/2022] Open
Abstract
Myositis ossificans (MO) is a benign disorder where bone forms within muscles or other soft tissues. This condition usually follows trauma and is rare in pediatric patients. Here we present the case of a 2-year-old male who developed MO of his right elbow without obvious trauma to the area. Imaging of MO in the initial phase is highly unspecific and obtaining tissue samples through a biopsy can render misleading reports. In most cases MO is a self-limited process with complete resolution, however, some cases may present a diagnostic and therapeutic challenge.
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16
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Rai A, Fishman MDC, Rives AF, Slanetz PJ. Calcified Axillary Lesions on Mammography: Review and Management. JOURNAL OF BREAST IMAGING 2022; 4:537-546. [PMID: 38416948 DOI: 10.1093/jbi/wbac058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 03/01/2024]
Abstract
When interpreting mammography, breast radiologists may identify radiopaque densities in the axilla on the mediolateral oblique or lateral projections. When such densities are encountered, true calcifications must be differentiated from pseudocalcifications (artifact). Using imaging, breast radiologists should be able to localize the finding as being dermal, within the soft tissues, within a lymph node, or intramuscular. By combining the anatomic location with the clinical presentation and any other imaging findings, breast radiologists will be able to determine the most appropriate management.
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Affiliation(s)
- Aayushi Rai
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Michael D C Fishman
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Anna F Rives
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Priscilla J Slanetz
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
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17
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De Paolo M, Gracis M, Lacava G, Vapniarsky N, Arzi B. Management of bilateral pterygoid myositis ossificans-like lesion in dogs. Front Vet Sci 2022; 9:992728. [PMID: 36299639 PMCID: PMC9589040 DOI: 10.3389/fvets.2022.992728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 11/04/2022] Open
Abstract
Myositis ossificans (MO) and myositis ossificans-like lesions have been rarely described within the veterinary literature, and are even less common in the maxillofacial region. When MO affects the muscles of mastication, it can result in complete or partial inability to open the mouth. As with other conditions resulting in decreased or restricted mandibular range of motion, severe and potentially fatal sequelae such as difficulty with prehension, swallowing, and air exchange are possible. Diagnostic imaging is essential in achieving an accurate diagnosis and in formulating an appropriate treatment plan. In this “method” manuscript, we provide a detailed description of our approach to diagnosis and surgical management of MO-like lesions of the pterygoid muscles and describe our experience with two young French bulldogs.
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Affiliation(s)
- Mercedes De Paolo
- Dentistry and Oral Surgery Service, William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA, United States
| | | | | | - Natalia Vapniarsky
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States,*Correspondence: Boaz Arzi
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18
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Jogiya PD, Hind J, Sidhu GAS, Suryawanshi S, Amara VV, Ashwood N. A Rare Presentation of Myositis Ossificans in a Diabetic Individual. J Orthop Case Rep 2022; 12:50-53. [PMID: 36874884 PMCID: PMC9983389 DOI: 10.13107/jocr.2022.v12.i10.3362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Myositis ossificans (MO) is a disease with self-limiting, benign ossifying lesions. MO traumatica is most common cause and occurs after blunt trauma to muscle tissue and the most common site of occurrence is the anterior thigh often developing after an intramuscular hematoma. The pathophysiology of MO is not well understood. The association of myositis and diabetes is quite rare. Case Report A 57-year-old male presented with a discharging ulcer on the right lateral lower leg. A radiograph was carried out to ascertain the degree of bone involvement. However, the X-ray showed calcifications. Ultrasound, magnetic resonance imaging (MRI) and X-ray imaging were used to exclude malignant disorders such as osteomyelitis or osteosarcoma. The diagnosis of myositis ossificans was confirmed with MRI. As the patient had a background of diabetes, this could have led to MO as a result of the macrovascular complication of a discharging ulcer; hence, diabetes could be considered a risk factor for the disease. Conclusion The reader may appreciate that diabetic patients may present with MO and that repeated discharging ulcers may imitate the effects of physical trauma on calcifications. The specific take home message is that regardless of the apparent rarity of a disease and subversion to typical clinical presentation, it should still be considered. Furthermore, the exclusion of severe and malignant diseases which benign diseases may mimic is of utmost importance to correctly manage patients.
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Affiliation(s)
| | - Jamie Hind
- Department Trauma and Orthopaedics, Queen's Hospital, Burton, England
| | | | - Suraj Suryawanshi
- Department Trauma and Orthopaedics, Queen's Hospital, Burton, England
| | - Veda Vani Amara
- Department Trauma and Orthopaedics, Queen's Hospital, Burton, England
| | - Neil Ashwood
- Department Trauma and Orthopaedics, Queen's Hospital, Burton, England.,Department of Orthopaedics, Wolverhampton Research Institute, University of Wolverhampton, Wolverhampton. WV1 1LY
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19
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Hwang CD, Pagani CA, Nunez JH, Cherief M, Qin Q, Gomez-Salazar M, Kadaikal B, Kang H, Chowdary AR, Patel N, James AW, Levi B. Contemporary perspectives on heterotopic ossification. JCI Insight 2022; 7:158996. [PMID: 35866484 PMCID: PMC9431693 DOI: 10.1172/jci.insight.158996] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heterotopic ossification (HO) is the formation of ectopic bone that is primarily genetically driven (fibrodysplasia ossificans progressiva [FOP]) or acquired in the setting of trauma (tHO). HO has undergone intense investigation, especially over the last 50 years, as awareness has increased around improving clinical technologies and incidence, such as with ongoing wartime conflicts. Current treatments for tHO and FOP remain prophylactic and include NSAIDs and glucocorticoids, respectively, whereas other proposed therapeutic modalities exhibit prohibitive risk profiles. Contemporary studies have elucidated mechanisms behind tHO and FOP and have described new distinct niches independent of inflammation that regulate ectopic bone formation. These investigations have propagated a paradigm shift in the approach to treatment and management of a historically difficult surgical problem, with ongoing clinical trials and promising new targets.
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Affiliation(s)
- Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Chase A Pagani
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Balram Kadaikal
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heeseog Kang
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish R Chowdary
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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20
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Isse HM, Sereke SG, Vincent M, Zeridah M. Non-traumatic myositis ossificans circumscripta in the anterior abdominal wall of a seven-year-old Ugandan child: A case report. Clin Case Rep 2022; 10:e6145. [PMID: 35898744 PMCID: PMC9309742 DOI: 10.1002/ccr3.6145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 11/14/2022] Open
Abstract
Myositis ossificans circumscripta (MOC) is a benign and self-limiting heterotopic ossification in the subcutaneous fat, tendons, muscles, and nerves. It is commonly due to trauma and is frequently encountered in the arm, shoulder, thigh, and hand which are prone to trauma. Non-traumatic MOC arising from the abdominal muscles is extremely rare. We report a case of 7-year-old male child with a three-year history of progressive painless abdominal swelling in the left hypochondria region with no history of associated trauma. CT scan of the abdomen showed a well-defined hyperdense mass in the left external oblique muscle. Histological diagnosis confirmed myositis ossificans of the external oblique muscle. The mass was removed surgically with no immediate or late complications.
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Affiliation(s)
- Hamdi Mohamed Isse
- Department of Radiology and Radiotherapy, School of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Mboizi Vincent
- Department of Radiology and Radiotherapy, School of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Muyinda Zeridah
- Department of Radiology and Radiotherapy, School of MedicineMakerere University College of Health SciencesKampalaUganda
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21
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Slouma M, Abbes M, Amorri W, Dhahri R, Metoui L, Jrad GB, Lamine K, Boujemaa H, Gharsallah I, Louzir B. Myositis Ossificans: A Rare Etiology of Sciatica. J Clin Rheumatol 2022; 28:e678-e679. [PMID: 32101909 DOI: 10.1097/rhu.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Rim Dhahri
- From the Departments of Internal Medicine
| | | | - Ghofrane Ben Jrad
- Emergency, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Khaled Lamine
- Emergency, Military Hospital, Tunis El Manar University, Tunis, Tunisia
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22
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Xia AN, Wang JS. Giant nontraumatic myositis ossificans in a child: A case report. World J Clin Cases 2022; 10:2901-2907. [PMID: 35434084 PMCID: PMC8968807 DOI: 10.12998/wjcc.v10.i9.2901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/02/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.
CASE SUMMARY An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.
CONCLUSION Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.
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Affiliation(s)
- An-Ning Xia
- Department of Orthopedic, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
| | - Jiang-Sheng Wang
- Department of Orthopedic, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
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23
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Xia AN, Wang JS. Giant nontraumatic myositis ossificans in a child: A case report. World J Clin Cases 2022; 10:2899-2905. [DOI: 10.12998/wjcc.v10.i9.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.
CASE SUMMARY An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.
CONCLUSION Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.
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Affiliation(s)
- An-Ning Xia
- Department of Orthopedic, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
| | - Jiang-Sheng Wang
- Department of Orthopedic, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong Province, China
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24
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Myositis ossificans: a rare neonatal presentation. Pediatr Radiol 2022; 52:587-591. [PMID: 34601621 DOI: 10.1007/s00247-021-05204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/20/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Myositis ossificans is a benign, ossifying, soft-tissue pseudotumor that most commonly occurs in men ages 30-40 years after trauma. Myositis ossificans may also occur in children, but it is extremely rare in those younger than 10 years of age. While myositis ossificans can often mimic malignant soft-tissue tumors, it has many unique findings that can aid in diagnostic differentiation. This differentiation is critical to avoid unnecessary risk with potentially harmful procedures. We present a very unusual presentation of myositis ossificans in the immediate post-birth perinatal period, as well as a review of key imaging findings.
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25
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Walter SS, Fritz J. MRI of Muscular Neoplasms and Tumor-Like Lesions: A 2020 World Health Organization Classification-based Systematic Review. Semin Roentgenol 2022; 57:252-274. [DOI: 10.1053/j.ro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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26
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Freer F, Parry M, Botchu R. Intramuscular ossifying metastasis from oesophageal carcinoma, with a pattern distinct from myositis ossificans - A case report. J Clin Orthop Trauma 2021; 24:101725. [PMID: 34926153 PMCID: PMC8649789 DOI: 10.1016/j.jcot.2021.101725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022] Open
Abstract
Muscle metastasis is uncommon. We present second reported case of ossifying metastasis from oesophageal carcinoma and review the literature. Our case highlights the different patterns of ossification in muscle, which is essential to make the diagnosis of myositis ossificans, a "don't touch lesion" in contrast to muscle metastasis or tumour, that needs oncological management.
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Affiliation(s)
- F. Freer
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - M. Parry
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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27
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Liu D, Qi B, Huang Z, Pan Z. Fibro-Osseous Pseudotumor. Orthopedics 2021; 44:e713-e718. [PMID: 34618638 DOI: 10.3928/01477447-20211001-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fibro-osseous pseudotumor is an extremely rare subcutaneous benign ossifying lesion associated with bone formation that is most commonly seen in the hands, followed by the toes. Because the tumor has a certain degree of invasiveness, it is often mistaken for malignancy, which leads to radical, excessive treatment. Our case involved a 32-year-old man with lesions on the left index finger. We documented the detailed data of diagnosis, treatment, and follow-up. We also conducted a review and summarized the published cases to advance our understanding of the disease, provide more accurate diagnostic criteria, and avoid inappropriate surgical procedures. [Orthopedics. 2021;44(6):e713-e718.].
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28
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Nadig N, Jaber J, Cameron C, Antosh I. Traumatic Enthesophyte From a Chronic Pectoralis Major Tendon Rupture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00081. [PMID: 34398839 DOI: 10.2106/jbjs.cc.20.00698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CASE A 24-year-old active duty soldier with a chronic pectoralis major tendon rupture presented a year later with a bony lesion consistent with an enthesophyte at the humeral insertion. The patient continued to have pain that was affecting his activities of daily living and underwent surgical intervention. CONCLUSION Operative management with enthesophyte excision and pectoralis major tendon repair provided relief to the patient's symptoms and return to preinjury levels of function as evaluated with Tegner, single assessment numeric evaluation, and visual analog scale scores at the 2-year follow-up.
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Affiliation(s)
- Nischal Nadig
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Jamil Jaber
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Craig Cameron
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Ivan Antosh
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas
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Benson JC, Trejo-Lopez J, Boland-Froemming J, Pollock B, Hunt CH, Wald JT. Calcified Pseudoneoplasm of the Neuraxis. AJNR Am J Neuroradiol 2021; 42:1751-1754. [PMID: 34301639 DOI: 10.3174/ajnr.a7237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/04/2021] [Indexed: 11/07/2022]
Abstract
Calcified pseudoneoplasms of the neuraxis are extremely rare non-neoplastic lesions that can exist anywhere in the CNS. Although benign, the lesions can cause substantial neurologic symptoms, typically related to mass effect on adjacent structures. Calcified pseudoneoplasms of the neuraxis can also mimic other entities such as calcified oligodendrogliomas and meningiomas. Nevertheless, the lesions can usually be strongly suggested at the time of imaging due to a number of fairly unique imaging characteristics. Here, the clinical presentation of a patient with a posterior fossa calcified pseudoneoplasm of the neuraxis is described, along with its imaging and pathologic features.
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Affiliation(s)
- J C Benson
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
| | - J Trejo-Lopez
- Laboratory Medicine and Pathology (J.T.-L., J.B.-F.)
| | | | - B Pollock
- Neurologic Surgery (B.P.), Mayo Clinic, Rochester, Minnesota
| | - C H Hunt
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
| | - J T Wald
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
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Richter RH, Byerly D, Schultz D, Mansfield LT. Challenges in the Interpretation of MRI Examinations Without Radiographic Correlation: Pearls and Pitfalls to Avoid. Cureus 2021; 13:e16419. [PMID: 34414045 PMCID: PMC8364739 DOI: 10.7759/cureus.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
As physics introduces more complex and seemingly thorough techniques to evaluate patient symptoms, cross-sectional imaging, especially magnetic resonance imaging (MRI), seems like the modality of choice to best help patients. However, musculoskeletal radiology (MSK) requires not just the excellent soft-tissue contrast provided by MRI but also an evaluation of the aggressiveness of a lesion, a detailed evaluation of osseous anatomy or distribution of disease, and a way to easily identify calcifications and gas in soft tissue in order to make the correct diagnosis. This article will demonstrate, through numerous cases, the importance of radiographs in the full characterization of MSK-related pathology. It will focus on imaging pearls and pitfalls to avoid when radiographs are not available and discuss the findings that can be expected if comparison radiographs were available.
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Affiliation(s)
- Ryan H Richter
- Department of Radiology, Brooke Army Medical Center, San Antonio, USA
| | - Douglas Byerly
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, USA
- Department of Radiology, Wilford Hall Ambulatory Surgical Center, San Antonio, USA
| | - Donald Schultz
- Department of Radiology, Brooke Army Medical Center, San Antonio, USA
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Savvidou O, Papakonstantinou O, Lakiotaki E, Melissaridou D, Korkolopoulou P, Papagelopoulos PJ. Post-traumatic myositis ossificans: a benign lesion that simulates malignant bone and soft tissue tumours. EFORT Open Rev 2021; 6:572-583. [PMID: 34377549 PMCID: PMC8335958 DOI: 10.1302/2058-5241.6.210002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Myositis ossificans (MO) is a benign bone formation in an extra-skeletal location. The most common subtype of MO, the post-traumatic, usually develops in young males after a traumatic event or sports injury.MO may simulate malignant bone lesions such as extra-skeletal or surface osteosarcomas, or soft tissue sarcomas such as synovial sarcoma or undifferentiated pleomorphic sarcoma. In the early phase the diagnosis of MO is challenging because imaging and histopathological findings may be non-characteristic.Detailed medical history as well as clinical examination, follow-up imaging studies and histological assessment are crucial for a proper diagnosis. Early and accurate differential diagnosis between MO and malignant soft tissue and bone tumours is important to maximize. Cite this article: EFORT Open Rev 2021;6:572-583. DOI: 10.1302/2058-5241.6.210002.
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Affiliation(s)
- Olga Savvidou
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
- These authors contributed equally to this manuscript
| | - Olympia Papakonstantinou
- Second Department of Radiology, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Athens, Greece
- These authors contributed equally to this manuscript
| | - Eleftheria Lakiotaki
- First Department of Pathology, National and Kapodistrian University of Athens, LAIKON General Hospital, Athens, Greece
- These authors contributed equally to this manuscript
| | - Dimitra Melissaridou
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
| | - Pinelopi Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, LAIKON General Hospital, Athens, Greece
- Co-senior authors
| | - Panayiotis J. Papagelopoulos
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
- Co-senior authors
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Tang T, Han FG. Calcium pyrophosphate deposition disease of the temporomandibular joint invading the middle cranial fossa: Two case reports. World J Clin Cases 2021; 9:2662-2670. [PMID: 33889634 PMCID: PMC8040178 DOI: 10.12998/wjcc.v9.i11.2662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pseudogout is a benign joint lesion caused by the deposition of calcium pyro-phosphate dihydrate crystals, but it is invasive. Pseudogout of the temporo-mandibular joint (TMJ) is uncommon, and it rarely invades the skull base or penetrates into the middle cranial fossa. The disease has no characteristic clinical manifestations and is easily misdiagnosed.
CASE SUMMARY We present two cases of tophaceous pseudogout of the TMJ invading the middle cranial fossa. A 46-year-old woman with a history of diabetes for more than 10 years was admitted to the hospital due to swelling and pain in the right temporal region. Another patient, a 52-year-old man with a mass in the left TMJ for 6 years, was admitted to the hospital. Maxillofacial imaging showed a calcified mass and severe bone destruction of the skull base in the TMJ area. Both patients underwent excision of the lesion. The lesion was pathologically diagnosed as tophaceous pseudogout. The symptoms in these patients were relieved after surgery.
CONCLUSION Tophaceous pseudogout should be considered when there is a calcified mass in the TMJ with or without bone destruction. A pathological examination is the gold standard for diagnosing this disease. Surgical treatment is currently the recommended treatment, and the prognosis is good after surgery.
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Affiliation(s)
- Ting Tang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Fu-Gang Han
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Choi KH, Park SG, Baek JH, Lee W, Chang MC. Myositis ossificans causing ulnar neuropathy: a case report. J Int Med Res 2021; 49:3000605211002680. [PMID: 33771066 PMCID: PMC8166390 DOI: 10.1177/03000605211002680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Myositis ossificans (MO) can compress peripheral nerves and cause neuropathy. We herein describe a patient with ulnar neuropathy caused by MO at the medial elbow. A 28-year-old man with a drowsy mentality and multiple organ damage following a traffic accident was admitted to our hospital. After 3 weeks of postoperative care, the patient's mental status recovered. However, he complained of severe sharp pain in his left medial forearm and fourth and fifth fingers. He exhibited weak fifth finger abduction and wrist adduction. Severe elbow joint pain was elicited during range-of-motion testing of his left elbow. Ultrasound also showed an edematous, enlarged, hypoechoic ulnar nerve lying above the MO, and the MO outwardly displaced the ulnar nerve. Elbow radiographic examination, computed tomography, and magnetic resonance imaging revealed MO development and compression of the left ulnar nerve. The patient underwent surgery; the following day, his left medial forearm pain completely disappeared with slight improvement in the motor weakness of fifth finger abduction. Ultrasound is a useful tool to easily evaluate the presence of MO and compression of peripheral nerves caused by MO.
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Affiliation(s)
- Kyu Hwan Choi
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Sam-Guk Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jong Hyun Baek
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Wonho Lee
- Department of Radiology, Topspine Hospital, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Hallinan JTPD, Huang BK. Shoulder Tumor/Tumor-Like Lesions: What to Look for. Magn Reson Imaging Clin N Am 2021; 28:301-316. [PMID: 32241665 DOI: 10.1016/j.mric.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article discusses the most common tumor and tumor-like lesions arising at the shoulder. Osseous tumors of the shoulder rank second in incidence to those at the knee joint and include benign osteochondromas and myeloma or primary malignant lesions, such as osteosarcoma or chondrosarcomas. Soft tissue tumors are overwhelmingly benign, with lipomas predominating, although malignant lesions, such as liposarcomas, can occur. Numerous tumor-like lesions may arise from the joints or bursae, due to either underlying arthropathy and synovitis (eg, rheumatoid arthritis and amyloid) or related to conditions, including tenosynovial giant cell tumor and synovial osteochondromatosis.
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Affiliation(s)
- James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore 119074, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, 10 Medical Drive, Singapore 119074, Singapore.
| | - Brady K Huang
- Department of Radiology, University of California San Diego, School of Medicine, UCSD Teleradiology and Education Center, 408 Dickinson Street, Mail Code #8226, San Diego, CA 92103-8226, USA
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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Abstract
INTRODUCTION Fibro-osseous pseudotumor of the digit is a rare benign lesion of subcutaneous tissue that typically arises in the parabone site of the proximal phalanx in young adult females. The lesion is histopathologically characterized by fibroblastic proliferation and osteoid formation. Good prognosis following complete surgical excision of the tumor has been reported, with a very low recurrence rate and no reports of malignant transformation. Despite its benign clinical behavior, the lesion can be mistaken for a malignant neoplasm, such as an extraskeletal or parosteal osteosarcoma, in case of rapid growth, thereby rendering the diagnosis challenging. PATIENT CONCERNS We report the case of a 30-year-old right-handed male who presented to our hospital with a rapidly growing mass on the dorsal aspect of the right little finger. DIAGNOSIS The patient was suspected to have soft tissue tumor of the little finger. The lesion could be considered a malignant tumor on the basis of clinical findings. INTERVENTIONS The patient underwent surgery for exploration and excision of the mass. OUTCOMES The excised mass was diagnosed to be fibro-osseous pseudotumor of the digit upon histological assessment. Postoperatively, the wound healed without complications. At postoperative 6 months, there were no signs or symptoms of recurrence, and the patient returned to his premorbid functional status. CONCLUSION Following the detection of a soft tissue mass with clinicopathological features of pseudomalignancy in the digit, clinicians should consider fibro-osseous pseudotumor of the digit as a possible diagnosis, thereby avoiding unnecessary aggressive surgery.
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Almeer G, Azzopardi C, Kho J, Botchu R. Myositis ossificans of mobile wad of Henry-Tennis elbow mimic. Indian J Radiol Imaging 2020; 30:89-91. [PMID: 32476757 PMCID: PMC7240889 DOI: 10.4103/ijri.ijri_453_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/17/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Lateral epicondylitis also known as “tennis elbow” is the most common cause of lateral elbow pain. Several pathologies can mimic symptoms of tennis elbow. We present a case of myositis ossificans within the mobile wad of Henry (MWH), which presented with symptoms of tennis elbow and believe this to be the first reported case in literature.
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Affiliation(s)
- Ghassan Almeer
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - James Kho
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Heterotopic ossification: radiological and pathological review. Radiol Oncol 2019; 53:275-284. [PMID: 31553710 PMCID: PMC6765162 DOI: 10.2478/raon-2019-0039] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Heterotopic Ossification (HO) is a common condition referring to ectopic bone formation in soft tissues. It has two major etiologies, acquired (more common) and genetic. The acquired form is closely related to tissue trauma. The exact pathogenesis of this disease remains unclear; however, there is ongoing research in prophylactic and therapeutic treatments that is promising. Conclusions Due to HO potential to cause disability, it is so important to differentiate it from other causes in order to establish the best possible management.
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McCabe P, Bayer T. Pretibial Panniculitis Ossificans-A Rare but Significant Diagnosis. J Foot Ankle Surg 2019; 58:775-778. [PMID: 31079981 DOI: 10.1053/j.jfas.2018.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 02/03/2023]
Abstract
Pretibial panniculitis ossificans is a rare condition. In this report, we describe a 67-year-old male localized to his right pretibial tissue, approximately 20 years after contusion to the same area.
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Affiliation(s)
- Patrick McCabe
- Senior House Officer, Midlands Regional Hospital, Tullamore, Ireland.
| | - Thomas Bayer
- Consultant Orthopaedic Surgeon, Midland Regional Hospital, Tullamore, Ireland
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40
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Ryan LE, Nickel CJ, Padhya T. A Posterior Triangle Neck Mass in a Pediatric Patient. JAMA Otolaryngol Head Neck Surg 2019; 145:87-88. [PMID: 30452516 DOI: 10.1001/jamaoto.2018.2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lindsey E Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Christopher J Nickel
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Tapan Padhya
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Abstract
Melorheostosis is a benign hyperostotic disease of the peripheral skeleton, rarely involving the axial skeleton. This disease is associated with ossified and non-ossified soft tissue masses surrounding the joints. We report the case of a 28-year-old male who presented to an orthopedic clinic with a chronic history of right leg pain. Radiological evaluation using X-ray, computed tomography, and magnetic resonance imaging showed features consistent with that of melorheostosis. Recognition of this entity by clinicians can avoid unnecessary investigations and biopsy.
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42
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Elbow Myositis Ossificans: Radiographic Evolution With Histologic Correlation. Am J Phys Med Rehabil 2018; 98:e88-e89. [PMID: 30461430 DOI: 10.1097/phm.0000000000001100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jawadi T, AlShomer F, Al-Motairi M, Al-Qahtani A, Alfowzan M, Almeshal O. Fibro-osseous pseudotumor of the digit: Case report and surgical experience with extensive digital lesion abutting on neurovascular bundles. Ann Med Surg (Lond) 2018; 35:158-162. [PMID: 30310678 PMCID: PMC6176746 DOI: 10.1016/j.amsu.2018.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue characterized by fibroblastic proliferation and osteoid formation. Herein, we present a case of massive FOPD lesion in the base of ring finger with extensive involvement of the neurovascular bundles with challenging surgical approach. Case description A 27-year old female patient, presented with 7-months history of a progressively enlarging mass on her left hand. Upon assessment, the mass was located over the proximal phalanx of the left ring finger with extensive involvement of the 4th web space. Her neurovascular examination was normal. Radiological investigations showed partial involvement of the radial sided bundle together with complete involvement of the ulnar sided neurovascular bundle. The patient was bothered by the mass being painful with overlying skin ulceration. She was taken afterwards to the operating room where the mass was dissected freely from those bundles while preserving the radial and ulnar structures. The resected margins were however, positive for residual lesions due to the extensive nature of the mass. The patient was informed about the need for close follow-ups for both clinical and radiological signs of lesion recurrence pending early surgical intervention. Conclusion FOPD although benign, a soft tissue osteosarcoma is one of the differential diagnosis. Meticulous attention to the clinical, pathological and histological features of FOPD is required. Early diagnosis and treatment of FOPD is very crucial in optimizing the overall outcome. Pre-operative planning with various radiological modalities was of great help anticipating the surgical course.
Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue. The differential diagnosis includes: myositis ossificans, extraskeletal osteosarcoma, parosteal osteosarcoma. Meticulous pre-operative planning is of great importance to optimize patient outcome. Fibro-osseous pseudotumor (FOPD) although benign, complete excision assure lack of recurrence. Meticulous histological assessment for any features of malignancy assure proper patient outcome.
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Affiliation(s)
- Tariq Jawadi
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Feras AlShomer
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Muhammed Al-Motairi
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Abdullah Al-Qahtani
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Mohammad Alfowzan
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
| | - Obaid Almeshal
- Plastic and Reconstructive Surgery, Surgery Department, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Saudi Arabia
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Abstract
A wide range of musculoskeletal processes can demonstrate increased uptake on PET-computed tomography (CT) with fluorodeoxyglucose (FDG) F 18, including reactive, benign neoplastic, inflammatory, traumatic, posttreatment, and arthritic conditions that may mimic malignancy. In addition, physiologic causes of increased FDG uptake such as asymmetric muscle use and presence of brown fat can lead to increased FDG uptake and potential false-positive results. This article presents various case examples of non-malignant musculoskeletal hypermetabolism on 18F-FDG PET-CT and describes useful tools to avoid the potential pitfall of misinterpreting these as malignancy.
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45
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Kayal L, Manoharan GVMG, Joshi B. Myositis Ossificans of the Masseter Muscle. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2018; 6:119-120. [PMID: 30787834 PMCID: PMC6196708 DOI: 10.4103/sjmms.sjmms_100_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L Kayal
- Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Affiliated with Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - G V Murali Gopika Manoharan
- Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Affiliated with Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - Bhaumik Joshi
- Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Affiliated with Tamil Nadu Dr. MGR Medical University, Chennai, Tamil Nadu, India
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46
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Caro-Domínguez P, Navarro OM. Imaging appearances of soft-tissue tumors of the pediatric foot: review of a 15-year experience at a tertiary pediatric hospital. Pediatr Radiol 2017; 47:1555-1571. [PMID: 29075896 DOI: 10.1007/s00247-017-3940-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 06/30/2017] [Indexed: 01/27/2023]
Abstract
Tumors of the foot are rare in children. In this review the authors illustrate radiographic, sonographic and MR imaging findings of foot soft-tissue tumors in children based on all cases presenting at a tertiary pediatric hospital during the 15-year period of 1999-2014. Among these cases there were 155 tumors of the foot - 72 of the bones and 83 of the soft tissues. Vascular malformations, fibromatosis and sarcomas were respectively the most frequent benign, intermediate and malignant soft-tissue tumors. Some tumors showed specific imaging findings. In imaging investigations, ultrasound can be used as the first imaging modality for diagnostic workup of most lesions because it is noninvasive, low-cost and readily available, and can confirm the presence of the mass and evaluate cystic components, especially in young children who would otherwise require sedation for MR imaging. MR imaging is the reference standard technique because of its high tissue contrast, which allows for detection and characterization of soft-tissue and bone abnormalities. MR imaging is useful as the first imaging modality in select cases, including those with high suspicion of malignancy, very large lesions or pre-treatment lesions. Recognition of some typical imaging findings in pediatric soft-tissue foot tumors is helpful to establish diagnosis and facilitate patient management.
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Affiliation(s)
- Pablo Caro-Domínguez
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Diagnostic Imaging, Hospital San Juan de Dios, Health Time Group, Córdoba, Andalucía, Spain
| | - Oscar M Navarro
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. .,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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Galanis N, Stavraka C, Valavani E, Kirkos J. Unsupervised Exercise-Induced Myositis Ossificans in the Brachialis Muscle of a Young Healthy Male: A Case Report. Orthop J Sports Med 2017; 5:2325967117718780. [PMID: 28795074 PMCID: PMC5524241 DOI: 10.1177/2325967117718780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nikiforos Galanis
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Chara Stavraka
- Department of Cancer and Surgery, Imperial College London, Hammersmith Hospital, London, UK
| | - Evdoxia Valavani
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - John Kirkos
- Division of Sports Medicine, Department of Orthopaedics, General Hospital Papageorgiou, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
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48
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Affiliation(s)
- Simon O'Brien
- PRP Diagnostic Imaging Maitland; New South Wales Australia
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49
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Nishiguchi S, Sekine I, Kuroda S, Sato M, Kitagawa I. Myositis Ossificans of the Hip Due to Pyogenic Arthritis Caused by Campylobacter fetus Subspecies fetus. Intern Med 2017; 56:967-972. [PMID: 28420848 PMCID: PMC5465416 DOI: 10.2169/internalmedicine.56.7906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 61-year-old woman was admitted with severe hip pain causing immobility and high serum levels of inflammatory markers. The patient had a medical history of diabetes. She had been scheduled to undergo right hip replacement surgery for the treatment of osteoarthritis associated with gradually progressive pain. On admission, an enhanced abdominal computed tomography scan showed an abnormal increase in synovial fluid surrounding the right ilium, with piriformis muscle calcification. Subsequent blood and specimen cultures identified Campylobacter fetus subspecies fetus. This is a rare report of a case of myositis ossificans followed by C. fetus pyogenic arthritis of the hip.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Ichiro Sekine
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Shun Kuroda
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
| | - Morihiko Sato
- Department of Infection Control and Prevention, Shonan Kamakura General Hospital, Japan
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan
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50
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Purohit NB, King LJ. Ultrasound of lower limb sports injuries. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 23:149-57. [PMID: 27433251 DOI: 10.1177/1742271x15588809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Musculoskeletal ultrasound utilises high-frequency linear transducers to produce high-resolution images of soft tissue structures. It is an increasingly useful tool in the assessment of both acute and chronic musculoskeletal injuries; it is relatively cheap, portable and can be used to facilitate targeted injections. In this review paper, we aim to provide a summary on the normal and abnormal appearances of skeletal tissue in the setting of acute and chronic lower limb sporting injuries.
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Affiliation(s)
- Neeraj B Purohit
- Department of Musculoskeletal Radiology, University Hospital Southampton, Southampton, Hampshire, UK
| | - Leonard J King
- Department of Musculoskeletal Radiology, University Hospital Southampton, Southampton, Hampshire, UK
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