12 Interesting MSK Cases
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1 12 Interesting MSK Cases James F Griffith Department of Imaging and Interventional Radiology Prince of Wales Hospital
2 Case 1: 12-year-old boy Slipped and fell. Anterior knee pain and swelling
3 Knee pain
4 Knee pain
5 Knee pain Periosteal sleeve avulsion : adolescence Forced quadriceps contraction
6 Periosteal sleeve avulsion
7 Case 2: 45-year-old man Multiple joint pains x 3yr Wrist, shoulder, knee, ankle RA negative HLA B27 neg CRP ESR
8 Joint pains
9 Joint pains Currently treated as either peripheral SpA or seronegative RA
10 Case # 3: 37-year-old man Psoriasis Multiple joint pains
11 Knee pain
12 Case 4: 44-year-old female RA. Shoulder pain and swelling for 2 months
13 Shoulder swelling Rice bodies : hypointense on T1- and T2WI Chondroid bodies: hyperintense on T2WI
14 Case #5: 31-year old man
15 Case #5: 31-year old man Adductor tendon tear, sports hernia
16 Case #5: 31-year old man Adductor tendon tear, sports hernia
17 Case #6: 62-year-old man Ca Pancreas Proximal thigh mass x 2 months,? lipoma RIGHT SIDE TS LEFT SIDE TS
18 Hypertrophy tensor fascia lata RIGHT SIDE LS LEFT SIDE LS
19 Previous CT
20 Case #7: 67-year-old man Nasopharnygeal carcinoma Rxd with radiotherapy 1986 Supraclavicular mass X 2 months Came on after pushups. Static since then.
21 Clavicular mass
22 Ultrasound
23 CT
24 SUVmax 3.3 PET CT
25 Diagnosis Exuberant callus formation secondary to radiation-induced insufficiency fracture of the clavicle Biopsy Fibrosis and necrotic bone fragments Reactive granulation tissue No granuloma. No malignancy. Gram stain, TB, fungal culture: -ve
26 Case # 8: 17-year-old girl First presented aged 17 Bilateral UL (>left) + LEFT LL weakness x one year LUL first, then R UL, then L LL Wasting, weakness and hyperreflexia
27 Case #8:
28 2012
29 2012
30 2012 Neutral Flexed
31 Latest FU, June 2017 LUL function same Progressive RUL weakness & numbness Lower limbs similar
32 Follow-up MRI
33 Hirayama s Disease Sporadic, > adolescent males, insidious > Asian countries Muscle atrophy hand > forearm flexor, branchioradialis typically preserved Finger tremor and cold paresis Sensory symptoms less Progression stops after 2-3 years in most patients and before 5 years in 75%
34 Proposed Mechanisms Cervical spinal cord compressed by anterior shift of the posterior dura during neck flexion leading to ischemic necrosis of cord (esp. anterior horns) Cervical Flexion Myelopathy (CFM)
35 MRI Features Normal + cord atrophy in neutral position Anterior shift of the posterior dura mater during flexion with flattening of the spinal cord against mid-cervical vertebral bodies Contrast enhancement of crescent-shaped posterior cervical epidural space
36 Treatment Conservative : Neck collar Arthrodesis (Anterior or Posterior) + Duraplasty Duraplasty alone Laminoplasty + Duraplasty
37 Case # 9: 37-year-old man Chronic disease Enlarging mass foot x 2 yesrs,? malignancy
38 Radiographs
39 Ultrasound
40 CT
41 CT
42 Case # 10: 35-year-old female Left lower quadrant pain x 2 months CS for IUD 2010 in Philippines
43 CT? infection in scar,? sarcoma
44 Ultrasound
45 Ultrasound Endometriosis
46 Case #11: 70-year-old female Umbilical mass x 1 month CT (private): large pelvic mass, most likely ovarian and umbilical mass Bx: poorly differentiated carcinoma
47 Case #11: 52-year-old female TAHBSO St Theresa in Umbilical pain and tenderness x 2 weeks Infarcted infected mesenteric fat confirmed at surgery Grew staph.
48 Case #12: 52-year-old female Enlarging thigh mass x 10 years
49 CT
50 Biopsy Osteoid and chondroid elements, no suspicious features : osteochondroma of soft parts
51 Post-op
52 Thank you
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