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Skull eosinophilic granuloma
Well defined lytic lesion with scalloped edges. It involves both the inner and outer table. Narrow zone of transition, no cortical breakthrough and no soft tissue component.
* Presents with acute abdominal pain
* Previous history adnex extirpation and appendectomy
* No raised inflammatory parameters
* No peristalsis
* CT abdomen with IV contrast
What do you see?
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Dilated small bowel loops, radiating distribution (“Bunch of grapes”) with impressive mesenterial venous engorgement and edema in the centre. Ascites perihepatic and in Douglas. Loss of bowel enhancement.
What is the most likely diagnosis?
Closed loop obstruction with bowel ischemia.
Seek for 2 (!) calibre changes next to each other to confirm SBO on basis of Closed loop obstruction.
Peroperative 1 meter of necrotic small bowel was resected.
Moth-eaten destructive permeative lytic lesion with wide zone of transition. There is cortical disruption of both the inner and outer table of the skull and a large soft tissue component.
An MRI is performed.What does the MRI show?
Destructive bone lesion with a large soft tissue component which is low signal intensity on T1, heterogenous intermediate signal on T2, and heterogeneous intense enhancement in the post contrast image. It causes mass effect on the adjacent brain parenchyma with no gross invasion.
What is the differential diagnosis?
Given the age of the patient the differential diagnosis includes:
* Osteosarcoma: most common primary bone tumor in young adults. Usually involves the metaphyseal regions of long bones but can occur at other sites. Aggressive lesion with sunburst periosteal reaction and calcified osteoid matrix.
* Ewing's sarcoma: second most common childhood bone tumor. Typically an aggressive permeative tumor which arises within the medullary cavity of the bone and has a large soft tissue component.