Olecranon lesions: Radiographic Appearances with Cross Sectional Imaging Correlation

Transcription

1 Olecranon lesions: Radiographic Appearances with Cross Sectional Imaging Correlation Poster No.: P-0107 Congress: ESSR 2014 Type: Educational Poster Authors: U. Kularatne, N. Evans, S. L. J. James ; Nottingham/UK, Birmingham/UK Keywords: Cancer, Perception image, Conventional radiography, MR, CT, Musculoskeletal bone, Extremities, Bones DOI: /essr2014/P-0107 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 15

2 Learning objectives To present a pictorial review of tumours and tumour mimics manifesting in the olecranon. Background Although rare, a wide range of tumours can manifest in the olecranon. Other disease processes such as infection and degenerative change may have similar imaging appearances. Awareness of the imaging appearances of the range of disease processes that can affect the olecranon helps arrive at a differential diagnosis. Imaging findings OR Procedure Details We present imaging appearances of histologically proven tumours and tumour mimics manifesting in the olecranon. The tumours include aneurysmal bone cyst (Fig. 3 on page 2), chondroblastoma (Fig. 4 on page 3), chondrosarcoma (Fig. 5 on page 4), fibrous dysplasia (Fig. 6 on page 5), metastasis (Fig. 7 on page 6), osteoid osteoma (Fig. 8 on page 7) and plasmacytoma (Fig. 9 on page 8). Tumour mimics include geode (Fig. 10 on page 9), haemophilic pseudotumour (Fig. 11 on page 10), Paget's disease (Fig. 12 on page 11) and tuberculosis (Fig. 13 on page 12). Images for this section: Page 2 of 15

3 Fig. 3: Aneurysmal bone cyst in a 12 year old female. AP (a) and lateral (b) radiographs show an expansile lucent lesion within the olecranon with multiple septations within it. Axial T1 (c), fat saturated T2 (d) and sagittal T1 (e) and STIR (f) MR images demonstrate an expansile lesion with multiple cystic cavities. Page 3 of 15

4 Fig. 4: Chondroblastoma in a 39 year old male. AP (a) and lateral (b) radiographs and axial (c) and sagittal (d) CT images show a well defined expansile lytic lesion with a scalloped cortical border in the olecranon. There is an associated pathological fracture.the lesion demonstrates intermediate signal intensity on axial T1 weighted MR image (e). It is hyperintense on sagittal STIR image (f) with surrounding soft tissue oedema. Page 4 of 15

5 Fig. 5: Chondrosarcoma in a 82 year old male. Lateral (a) and AP (b) radiographs show a fracture through a lytic lesion with popcorn-like calcification within it and in the adjacent soft tissue. Sagittal T1 weighted MR image (c) shows an intermediate signal lobular mass. T2 weighted image (d) shows areas of low signal intensity representing mineralisation within a high signal intensity lesion. Page 5 of 15

6 Fig. 6: Fibrous dysplasia in a 45 year old male. Coronal (a) and sagittal (b) CT images show a well defined ground-glass lucency with a sclerotic margin. Coronal T1 weighted (c) and proton density fat saturated (d), axial T1 weighted (e) and sagittal T2 weighted (f) MR images show a well defined homogeneous lesion surrounded by a sclerotic margin. It has intermediate to low signal intensity in T1 and T2 weighted sequences due to its fibrous nature. Page 6 of 15

7 Fig. 7: Metastasis in a 56 year old female. AP (a) and lateral (b) radiographs and CT images obtained in a slightly oblique coronal (c) and sagittal (d) plane show infiltrative change within the olecranon. Heterogeneous low signal intensity on sagittal T1 weighted MR image (e) and high signal intensity on STIR image (f) represent diffuse infiltration within the olecranon. Page 7 of 15

8 Fig. 8: Osteoid osteoma in 17 year old male. AP (a) and lateral (b) radiographs show diffuse sclerosis with a focal lucent area within the olecranon. Coronal (c) and sagittal (d) CT images show a well defined lucent nidus with central mineralisation within a background of diffuse sclerosis. Coronal STIR MR image (e) shows bone marrow and soft tissue oedema surrounding the nidus which is isointense to muscle on T1 weighted fat saturated image (f). Page 8 of 15

9 Fig. 9: Plasmacytoma in a 45 year old female. AP (a) and lateral (b) radiographs show a 'bubbly' expansile lesion in the olecranon. Axial T1 weighted MR image (c) shows intermediate signal areas within the lesion likely due to post radiotherapy changes. Sagittal STIR image (d) shows diffuse hyperintensity within the lesion. Page 9 of 15

10 Fig. 10: Geode in a 49 year old male. AP (a) and lateral (b) radiographs show a cystic lesion with a sclerotic margin. There is marked arthropathy within the elbow joint with loose body formation. Axial T1 (c) and T2 (d), coronal T1 (e) and sagittal T2 (f) weighted MR images show a lesion following fluid signal in all sequences. Page 10 of 15

11 Fig. 11: A pseudo tumour in a 26 year old male with haemophilia. AP (a) and lateral (b) radiographs show a multiloculated lytic lesion with endosteal scalloping in the olecranon. Axial (c) and sagittal (d) CT images show an intramedullary cystic expansile lesion. Superimposed degenerative changes are present in the elbow joint. Page 11 of 15

12 Fig. 12: Paget's disease in a 61 year old male. AP (a) and lateral (b) radiographs show cortical thickening and trabecular coarsening within the olecranon. Axial (C) and coronal (e) T1 weighted MR images show thickening of the ulnar cortex. Patchy areas of decreased signal intensity within the marrow represent fibrovascular connective tissue. Axial (d) and coronal (f) STIR images show high signal intensity in the corresponding areas. Page 12 of 15

13 Fig. 13: Tubuerculosis in a 39 year old female. AP (a) and lateral (b) radiographs show a poorly defined lucent lesion in the olecranon.pre-contrast axial (c) and post contrast axial (d), coronal (e) and sagittal (f) T1 weighted fat saturated MR images show an ill defined lesion. There is diffuse medullary enhancement post-contrast. Page 13 of 15

14 Conclusion Awareness of the imaging appearances of tumours and other disease processes manifesting in the olecranon helps arrive at a differential diagnosis when encountering these rare lesions. In our experience, imaging appearances alone are often not sufficient to diagnose lesions within the olecranon accurately. For lesions posing a diagnostic dilemma, we recommend appropriate staging and discussion in a bone tumour multi disciplinary meeting with a view to biopsy. References Stoller DW, Tirman PFJ, Bredella MA. Diagnostic Imaging: Orthopaedics. Salt Lake City: Amirsys; Walter H, Schneider-Stock R, Mellin W, Günther T, Nebelung W, Roessner A. Synchronous multifocal bone sarcomas: a case report and molecular pathologic investigation. Gen Diagn Pathol May;141(1): Matsumoto K, Hukuda S, Ishizawa M, Saruhashi Y, Okabe H, Asano Y. Parosteal (juxtacortical) chondrosarcoma of the humerus associated with regional lymph node metastasis. A case report. Clin Orthop Relat Res 1993 May;(290): Dahnert W. Radiology Review Manual Seventh Edition. Philadelphia: Lippincott Williams & Wilkins: Saifuddin A. Musculoskeletal MRI. London: Hodder Arnold Klepsch M, Seidel T, Runkel M. Paget's disease of the proximal ulna: a rare monostotic manifestation. Z Orthop Ihre Grezgeb 1997 MayJun;135(3): Culleton S, de Sa E, Christakis M, Ford M, Zbieranowski I, Sinclair E, Cheung P, Campos S, Goh P, Chow E. Rare bone metastases of the olecranon. J Palliat Med Oct:11(8): Cassard X, Accadbled F, De Gauzy JS, Cahuzac JP. Osteoid osteoma of the elbow in children: a report of three cases and a review of the literature. J Pediatr Orthop B Jul:11(3) Dhillon MS, Goel A, Prabhakar s, Aggarwal S, Bachhal V. Tuberculosis of the elbow: A clinicoradiological analysis. Indian J Orthop Mar;46(2): Personal Information Page 14 of 15

15 Udara Kularatne Registrar in Musculoskeletal Radiology Nick Evans Consultant Musculoskeletal Radiologist Steven James Consultant Musculoskeletal Radiologist Radiology Department The Royal Orthopaedic Hospital Bristol Road South Birmingham B31 2AP UK Correspondence to Page 15 of 15