welcome to the next season of the blog!
During September I will show cases that I have seen this summer. Today’s radiograph belong to a 23-year-old woman who couldn’t elevate her left arm more than twenty degrees.
What do you see?
Come back on Friday to see the answer!
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Findings: AP radiograph of the left shoulder shows numerous rounded calcifications projected over the scapula and humeral head (A, circle). The first diagnosis that comes to mind is osteopoikilosis but, given the patient’s symptoms, chondromatosis of the shoulder should be considered.
The dilemma is easily solved by taking a comparison view of the contralateral shoulder, which shows identical findings (B and C, circles).
The patient’s mother was a physician and very anxious. She insisted in taking a radiograph of the pelvis, which again shows the typical findings of osteopoikilosis
Final diagnosis: unsuspected osteopoikilosis
Congratulations to Zehra who was the first to suggest the correct diagnosis.
Teaching point: remember the usefulness of comparison films in MSK imaging
P. S. This a warm-up case to facilitate your return to the Diploma cases. Next week will be more difficult!
15 thoughts on “Cáceres’ Corner Case 209 – SOLVED”
Ostoarthritic changes of glenoid articular surface
Multiple well-defined nodules in the left shoulder. Young patient lacking signs of degenerative disease. I think of primary synovial chondromatosis
I see small sclerotic foci compatible with multiple enostosis on humeral head and glenoid process. I would suggest osteopoikilosis however since it is an asymptomatic condition, I suspect one of the sclerotic foci could represent soft tissue calcification of rotator cuff tendons. A lateral shoulder radiograph and if needed shoulder ultrasound could further shed light on the condition.
Humeral head shows as if multiple osteomas, osteopoikilosis
Oblique view is recommended
You are offering two different diagnosis. What would you do if the oblique view is non-contributory?
I would perform a CT scan to see if the calcifications are intrasynovial.
By the way, osteopoikilosis is asymptomatic and we are facing a young woman with a significant restricted range of movement
I made the same comment when the case was shown to me. But I suggested a simpler examination.
Simpler than that: comparison film of the other shoulder
multiple welldefined rounded sclerotic lesions seen within the left shoulder joint …synovial osteochondromatosis
Multiple almost uniform in appearance sclerotic foci with peri articular in distribution, picture of multiple bone osteomalacia; Osteopoikilosis
I think there is a supraclavicular soft tissue mass that is the aetiology of the arm´s reduced movility. In my opinion the blastic lesions are a casual finding…
No and yes .-)
Myositis ossificans? Osteopoikilosis?