What do you see?
Vertebral hemangioma with thickened trabeculae and fat foci inside the lesion, without soft tissue component with an associated pathological fracture.
TEACHING POINTS:
Bone hemangiomas are very frequent, atypical presentations and complications (like in this cases with soft tissue component and pathological fracture) are rare but radiologist must be aware of them to be able to make the correct diagnosis.
65-year-old man. Paraplegia after skiing accident. What do you see?
Complete low dorsal transdiskal and transvertebral fracture with extension to middle and posterior columns on an ankylosed spine.
Sever posterior angulation and displacement of the superior segment cord deformity, compression and myelopathy.
Severe complete unstable ankylosed spine fracture with cord compression and mielopathy
Ankylosed spine show specific patterns of fracture with: higher tendency to three column involvement, and increased frequency of neurologic complications.
72-year-old alcoholic patient with intractable dorsal pain and legs numbness and weakness.
What do you see?
Thoracic spine compression fracture with posterior displacement of the posterior wall of the vertebral body compromising the spinal canal, cord compression and associated myelopathy. T2W image shows fluid and hypointense bubble-like artifact consistent with vacuum cleft in the collapsed anterior vertebral body
Kümmel disease (osteonecrosis and collapse of the vertebral body)
Intravertebral vacuum cleft and fluid within the collapsed vertebral body is a characteristic feature
Differential diagnosis includes a pathologic (tumoral) fracture, and the presence of air strongly favors osteonecrosis
Would you like to see a complementary case?
MR T2-weighted and CT images to highlight the characteristic features of Kümmel disease
Intravertebral fluid seen on T2 image and air on CT image
A 20-year-old male. Fell off motor. Pain and swelling right wrist/hand.
What do you see?
Scaphoid fracture with perilunate dislocation. Also oblique non-displaced fracture of 3rd metacarpal
27-year-old patient with neurofibromatosis-type 1 (NF-1). Bone lesions found on PET-CT
Multiple bilateral multiloculated eccentric metaphyseal lucent lesions with thin sclerotic rim
Multiple non-ossifying fibromas in a patient with NF-1
Very common benign lesion in young adults. Tend to heal or involute. Vast majority asymptomatic. Large lesions may be painful or weaken the cortical predisposing to pathological fracture (rare). Multiple in NF-1
2-year-old girl, referring to emergency department after a fall.
What do you see?
– An expansile lytic lesion with ill-defined margins (green arrow) is seen on the diaphysis of fibula.
– Lamellated periosteal reaction (red arrow) suggests an aggressive lesion.
Differential diagnosis of an aggressive lytic lesion in a 2-year-old child includes:
– Osteomyelitis
– Ewing’s sarcoma
– Langerhans cell histiocytosis
– Leukemia/lymphoma
An MRI scan
Intramedullary hyperintense lesion with extensive surrounding soft tissue and bone marrow edema on coronal STIR image (a) is seen. The lesion is hypointense on T1 WI (b).
Postcontrast coronal (a) and axial fat-suppressed (b) T1-weighted images show extensive enhancement in the lesion and the surrounding soft tissue
Histopathologic examination revealed Langerhans cell histiocytosis.
– LCH is characterised by idiopathic infiltration and accumulation of abnormal histiocytes within various tissues.
– Bone is the most commonly affected tissue in children, with a predilection for axial bones, and femur is the most commonly affected long bone.
– Radiographic appearance of the lesions depends on the site of involvement and the phase of the disease.
– Skull: Calvarium is more affected than the skull base, typically seen as single or multiple well-defined lytic lesions on radiography; T1 hypointense, T2 hyperintense with significant enhancement on MRI. Temporal bone is the most common affected part of skull base seen as destructive lesions with a soft tissue component.
– Spine: Vertebral bodies are affected with relative sparing of posterior elements. A typical vertebra plana appearance may be encountered with total collapse.
– Long bones: Ill-defined lytic lesions with/without cortical destruction are seen usually located at diaphysis or metaphysis. Periosteal reaction may be present. Extensive bone marrow and soft tissue signal changes on MRI may also be helpful in the diagnosis.
63-year-old patient with knee pain. What do you see?
Lucent distal femur epiphyseal lesion with thin sclerotic borders and rings-and-archs calcifications, characteristic of chondral matrix
Enchondroma
Malignant counterpart chondrosarcoma in spinous process of lumbar spinal vertebra
What do you see?
Enchondroma
Characteristic findings: location epiphysis, thin sclerotic borders and rings-and-archs calcifications
It might be indistinguishable from chondrosarcoma on imaging, and pain may raise the latter suspicion
If bone aggressive lysis, striking endosteal scalloping or soft tissue component is present,
This is the third and last case of the musculoskeletal series. Check the first one and second one on this blog.
What do you see on the following images?
Osteoblastoma: Osteoblastoma is histologically similar to osteoid osteoma but they are larger (usually accepted more than 1 cm), often involving the posterior column
We are continuing the same topic we started 3 weeks ago. You can check the first part also in this blog.
What do you see on this images?
Vertebral osteoid-osteoma case in the articular facet of lumbar vertebrae with less cortical reaction but with almost pathognomonic nidus
43-year-old healthy patient:
– with fibromyalgia
– No other relevant medical history
What do you see on the following images?
Multiple focal sclerotic bone lesions clustered around joints in both knees and sacroiliac joints
Osteopoikilosis
Sclerosing bony dysplasia characterized by multiple enostoses
Typically clustered around joints, aligned parallel to trabeculae. Usually 1-3 mm, they can reach up to 20 mm
Rare condition; inherited; asymptomatic; incidental
Important to avoid misdiagnosis with other relevant pathologies such as metastasis
