DOCSLIB.ORG

Knee Pain in Children, Part II: Limb- and Life-Threatening Conditions, Hip Pathology, and Effusion

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Knee Pain in Children, Part II: Limb- and Life-Threatening Conditions, Hip Pathology, and Effusion Knee Pain in Children, Part II: Limb- and Life-threatening Conditions, Hip Pathology, and Effusion Michael Wolf, MD* *Pediatrics and Orthopedic Surgery, St Christopher’s Hospital for Children, Philadelphia, PA. Practice Gap Clinicians who evaluate knee pain must be able to recognize limb- and life-threatening conditions, hip pathology, or joint effusion and pursue the appropriate management. Objectives After reading the article, the reader should be able to: 1. Describe the presentation and treatment of common limb- and life-threatening conditions that can cause knee pain in children. 2. Delineate how hip pathology can contribute to knee pain in children and how such conditions should be diagnosed and treated. 3. Explain the diagnosis and treatment of conditions that may cause effusion in conjunction with knee pain in children. INTRODUCTION As noted in the first part of this three-part review of knee pain in children, the clinician can use the information gained from the history and physical examination in an algorithm to establish a working diagnosis and direct subsequent evaluation and management. The initial priorities are to identify emergent limb- and life-threatening conditions, hip pathology, or effusion (Table). LIMB- AND LIFE-THREATENING CONDITIONS Bacterial Infections Septic Arthritis. The knee is the most common site of septic arthritis in children. Usually, septic arthritis is characterized by the acute onset of steadily progressive knee pain with fever and a physical examination demonstrating effusion, warmth, AUTHOR DISCLOSURE Dr Wolf has disclosed fi erythema, and limited motion. Concern for septic bacterial arthritis in children no nancial relationships relevant to this article. This commentary does not contain a warrants emergent evaluation, including knee radiographs (anteroposterior [AP] discussion of an unapproved/investigative and lateral) and laboratory studies (complete blood cell [CBC] count with use of a commercial product/device. 72 Pediatrics in Review Downloaded from http://pedsinreview.aappublications.org/ by guest on April 22, 2016 A reactive effusion may be present. If findings on the Specific Causes of Knee Pain in TABLE. evaluation are concerning for osteomyelitis, radiographs Children (AP and lateral of knee, femur, or tibia/fibula) and labo- ratory studies (CBC with differential count, ESR, CRP, Limb- and Life-threatening Conditions blood culture) should be obtained. If results suggest the • Bacterial Infection possibility of infection, MRI should be obtained. Evidence À Septic arthritis of focal soft-tissue or bone abscess necessitates surgical À Osteomyelitis debridement. Prolonged antibiotic therapy is the hallmark • Musculoskeletal and Systemic Malignancy of treatment. (1)(2)(3)(4)(5) À Osteosarcoma Musculoskeletal and Systemic Malignancies À Ewing sarcoma Although the overall incidence of malignancy is low, several À Primary bone lymphoma malignant conditions can present as knee pain, including À Soft-tissue malignancy primary bone lesions (Ewing sarcoma, osteosarcoma, pri- mary bone lymphoma), soft-tissue malignancies (rhabdo- À Leukemia myosarcoma, fibrosarcoma, liposarcoma), and leukemia. (6) Hip Pathology Children who present with knee pain and systemic • Slipped capital femoral epiphysis symptoms, nighttime pain, or a palpable mass should be Effusion After Trauma evaluated immediately for malignancy. The evaluation begins with radiographs of the knee (AP and lateral) and • Intra-articular fracture possible AP and lateral radiographs of the femur or tibia and • Cartilage injury fibula. Ewing sarcoma is associated with layers of periosteal • Cruciate ligament rupture reaction called “onion skinning.” Osteosarcoma is charac- • Meniscal injury terized by the radiographic finding of “sun bursting,” which fi • Patellar subluxation or dislocation represents calci ed blood vessels radiating out from the lesion. Leukemia frequently is associated with radiographic Effusion Without Trauma osseous abnormalities, including diffuse osteopenia, meta- • fl In ammatory Arthritis physeal bands, periosteal new bone formation, geographic À Juvenile idiopathic arthritides lytic lesions, sclerosis, mixed sclerosis/lysis, and permeat- À Other systemic inflammatory conditions that are associated ing destruction. (7)(8)(9)(10) with arthritis Depending on the degree of clinical concern, subsequent • Infectious Arthritis evaluation usually begins with an MRI and may include a À Lyme arthritis CBC with manual differential count or computed tomogra- phy scan. Laboratory studies looking for evidence of active À Gonococcal arthritis inflammation (ESR, CRP, antinuclear antibody [ANA] with À Viral arthritis reflexive titers) could also be considered. Any concern for malignancy should be directed to a pediatric oncologist for immediate evaluation. differential count, erythrocyte sedimentation rate [ESR], fl C-reactive protein [CRP], blood culture, and synovial uid HIP PATHOLOGY analysis that includes cell count and differential count, Gram stain, and culture). Magnetic resonance imaging Knee pain may be indicative of hip pathology, including (MRI) should be obtained to detect any adjacent osteomy- slipped capital femoral epiphysis. Hip pathology must be elitis. Children with bacterial arthritis often require open considered if there is concurrent hip or thigh pain with surgical drainage followed by prolonged antibiotic therapy. medial knee pain or the patient is unable to flex the hip to 90 (1)(2)(3) degrees or internally rotate the hip to 10 degrees without Osteomyelitis. Children who have osteomyelitis generally pain. The patient for whom the clinician has concern about present with a painful limp and systemic symptoms that are hip pathology must remain strictly nonweight-bearing until milder than those seen in septic arthritis. Physical examina- pelvis radiographs (AP and frog-leg lateral) are obtained to tion often reveals tenderness and limited joint motion. ensure the absence of emergent hip pathology. Vol. 37 No. 2 FEBRUARY 2016 73 Downloaded from http://pedsinreview.aappublications.org/ by guest on April 22, 2016 Slipped capital femoral epiphysis is pathology of the concurrent injuries, the patient should be urgently referred proximal femoral physis that results in displacement of for surgical evaluation. If the ACL rupture is isolated, the the proximal femoral epiphysis from the metaphysis. It primarycarephysicianmayinitiatephysicaltherapy. typically occurs in 10- to 16-year-old children. The patient A period of physical therapy before surgical reconstruction with a slipped capital femoral epiphysis who initially can improves outcomes in patients with isolated ACL ruptures tolerate weight-bearing but progresses to the point where who undergo surgical reconstruction, although isolated weight-bearing is intolerable has a significantly worse prog- ACL ruptures do not necessarily require surgical recon- nosis. Patients whose physical examination or radiographic struction. However, because only approximately 10% of findings are consistent with slipped capital femoral epiph- patients with an incompetent ACL are capable of compet- ysis should be made strictly nonweight-bearing and referred ing in athletics without further episodes of instability (and to the emergency department for further management. (11)(12) risk of further intra-articular derangement), most young athletes pursue immediate surgical reconstruction. A total EFFUSION AFTER TRAUMA of 6 to 9 months of rehabilitation is required after recon- struction before a return to sports can be considered. Studies If significant swelling develops after an acute traumatic of return to athletics after ACL reconstruction show mixed injury and there is evidence of effusion on physical exam- outcomes but generally positive results. After ACL rupture, ination, the clinician must consider intra-articular derange- the incidence of osteoarthritis increases significantly, regard- ment of the knee until proven otherwise. Intra-articular less of subsequent management. (19)(20)(21) derangement includes fractures (tibia, femur, fibula or The posterior cruciate ligament (PCL) prevents posterior patella), cartilage injury, cruciate ligament rupture, menis- translation of the tibia upon the femur. In most individuals, cal tear, and patellar subluxation or dislocation. Any concern the PCL is not crucial for knee stability. Patients with isolated for intra-articular derangement necessitates MRI of the PCL ruptures can be referred for rehabilitation and can usually knee without contrast. (13)(14)(15) return to a high level of athletics within a few months. (22) Intra-articular Fractures Intra-articular fractures are uncommon. They can occur to Meniscal Injury the femur, tibia, fibula, or patella. Any patient presenting with The menisci are specialized thickened cartilage tissues that traumatic knee pain, effusion, and bony tenderness needs stabilize and cushion the tibial-femoral joint. Each knee has radiographs (AP and lateral of knee) to assess for possible a lateral and medial meniscus. Patients with a meniscus intra-articular fracture. If fracture is present, the patient should injury present with pain, effusion, and often limited motion be made nonweight-bearing, the knee immobilized, and the and mechanical symptoms. Physical examination can reveal patient referred for emergent surgical evaluation. (16) limited range of motion and joint-line tenderness. Depend- ing on the location and size of the tear in the meniscus, Cartilage Injury patients may undergo meniscal repair, partial meniscec-
Load more

Recommended publications
  • Diagnosis and Treatment of Intramedullary Osteosclerosis
    Abe et al. BMC Musculoskeletal Disorders (2020) 21:762 https://doi.org/10.1186/s12891-020-03758-5 CASE REPORT Open Access Diagnosis and treatment of intramedullary osteosclerosis: a report of three cases and literature review Kensaku Abe, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi* , Shinji Miwa, Kentaro Igarashi, Takashi Higuchi, Yuta Taniguchi, Hirotaka Yonezawa, Yoshihiro Araki, Sei Morinaga, Yohei Asano and Hiroyuki Tsuchiya Abstract Background: Intramedullary osteosclerosis (IMOS) is a rare condition without specific radiological findings except for the osteosclerotic lesion and is not associated with family history and infection, trauma, or systemic illness. Although the diagnosis of IMOS is confirmed after excluding other osteosclerotic lesions, IMOS is not well known because of its rarity and no specific feature. Therefore, these situations might result in delayed diagnosis. Hence, this case report aimed to investigate three cases of IMOS and discuss imaging findings and clinical outcomes. Case presentation: All three cases were examined between 2015 and 2019. The location of osteosclerotic lesions were femoral diaphyses in the 60-year-old man (Case 1) and 41-year-old woman (Case 2) and tibial diaphysis in the 44-year-old woman (Case 3). All cases complained of severe pain and showed massive diaphyseal osteosclerotic lesions in plain radiograms and computed tomography (CT) scans. Cases 2 and 3 were examined using the triphasic bone scan, and a fusiform-shaped intense area of the tracer uptake on delayed bone image was detected in both cases without (Case 2) or slightly increased vascularity (Case 3) on the blood pool image, which was reported as a specific finding of IMOS.
    [Show full text]
  • (Osgood- Schlatter Disease): a Review
    Open Access Review Article DOI: 10.7759/cureus.780 Apophysitis of the Tibial Tuberosity (Osgood- Schlatter Disease): A Review Raju Vaishya 1 , Ahmad Tariq Azizi 2 , Amit Kumar Agarwal 1 , Vipul Vijay 1 1. Orthopaedics, Indraprastha Apollo Hospitals 2. Orthoapedics, Herat Regional Hospital, Herat, Afghanistan Corresponding author: Amit Kumar Agarwal, [email protected] Abstract Osgood-Schlatter disease (OSD) is a condition in which the patellar tendon insertion on the tibial tuberosity becomes inflamed. It is a well-known condition in late childhood characterized by pain and a bony prominence over the tibial tuberosity. The pain is usually exacerbated by physical activities like running, jumping, and climbing stairs. In the acute stage, the margins of the patellar tendon become blurred in radiographs due to the soft tissue swelling. After three to four months, bone fragmentation at the tibial tuberosity is viewed. In the sub-acute stage, soft tissue swelling resolves, but the bony ossicle remains. In the chronic stage, the bone fragment may fuse with the tibial tuberosity which can appear normal. The primary goal in the treatment of OSD is the reduction of pain and swelling over the tibial tuberosity. The patient should limit physical activities until the symptoms are resolved. In some cases, the patient should restrict physical activities for several months. The presence of pain with kneeling because of an ossicle that does not respond to conservative measures is the indication for surgery. In these cases, the removal of the ossicle, surrounding bursa, and the bony prominence is the treatment of choice. Categories: Orthopedics Keywords: tibial tuberosity, osgood-schlatter disease, apophysitis Introduction And Background Osgood-Schlatter disease (OSD, also called Lannelongue’s disease) is a condition in which the patellar tendon insertion on the tibial tuberosity becomes inflamed [1-2].
    [Show full text]
  • Radionuclide Bone Scintigraphy in Sports Injuries
    Radionuclide Bone Scintigraphy in Sports Injuries Hans Van der Wall, MBBS, PhD, FRACP,* Allen Lee, MBBS, MMed, FRANZCR, FRAACGP, DDU,† Michael Magee, MBBS, FRACP,* Clayton Frater, PhD, ANMT, BHSM,† Harindu Wijesinghe, MBBS, FRCP,‡ and Siri Kannangara, MBBS, FRACP†,§ Bone scintigraphy is one of the mainstays of molecular imaging. It has retained its relevance in the imaging of acute and chronic trauma and sporting injuries in particular. The basic reasons for its longevity are the high lesional conspicuity and technological changes in gamma camera design. The implementation of hybrid imaging devices with computed tomography scanners colocated with the gamma camera has revolutionized the technique by allowing a host of improvements in spatial resolution and anatomical registration. Both bone and soft-tissue lesions can be visualized and identified with greater and more convincing accuracy. The additional benefit of detecting injury before anatomical changes in high-level athletes has cost and performance advantages over other imaging modalities. The applications of the new imaging techniques will be illustrated in the setting of bone and soft-tissue trauma arising from sporting injuries. Semin Nucl Med 40:16-30 © 2010 Elsevier Inc. All rights reserved. he uptake characteristics of the bone-seeking radiophar- Scintigraphy is also capable of detecting bone bruising, an Tmaceuticals are highly conducive to the localization of acute injury resulting from direct trauma that leads to trabec- trauma to bone or its attached soft-tissue structures. Bone ular microfractures without frank cortical disruption.1 The scintigraphy has an inherently high contrast-resolution, greater force transmission involved in cortical fracture en- which enables the detection of the pathophysiology of sures early detection by three-phase scintigraphy.
    [Show full text]
  • Injuries and Normal Variants of the Pediatric Knee
    Revista Chilena de Radiología, año 2016. ARTÍCULO DE REVISIÓN Injuries and normal variants of the pediatric knee Cristián Padilla C.a,* , Cristián Quezada J.a,b, Nelson Flores N.a, Yorky Melipillán A.b and Tamara Ramírez P.b a. Imaging Center, Hospital Clínico Universidad de Chile, Santiago, Chile. b. Radiology Service, Hospital de Niños Roberto del Río, Santiago, Chile. Abstract: Knee pathology is a reason for consultation and a prevalent condition in children, which is why it is important to know both the normal variants as well as the most frequent pathologies. In this review a brief description is given of the main pathologies and normal variants that affect the knee in children, not only the main clinical characteristics but also the findings described in the different, most used imaging techniques (X-ray, ultrasound, computed tomography and magnetic resonance imaging [MRI]). Keywords: Knee; Paediatrics; Bone lesions. Introduction posteromedial distal femoral metaphysis, near the Pediatric knee imaging studies are used to evaluate insertion site of the medial twin muscle or adductor different conditions, whether traumatic, inflammatory, magnus1. It is a common finding on radiography and developmental or neoplastic. magnetic resonance imaging (MRI), incidental, with At a younger age the normal evolution of the more frequency between ages 10-15 years, although images during the skeletal development of the distal it can be present at any age until the physeal closure, femur, proximal tibia and proximal fibula should be after which it resolves1. In frontal radiography, it ap- known to avoid diagnostic errors. Older children and pears as a radiolucent, well circumscribed, cortical- adolescents present a higher frequency of traumatic based lesion with no associated soft tissue mass, with and athletic injuries.
    [Show full text]
  • Painful Foot Presented by L
    Postgrad Med J (1991) 67, 174- 175 © The Fellowship of Postgraduate Medicine, 1991 Postgrad Med J: first published as 10.1136/pgmj.67.784.174 on 1 February 1991. Downloaded from Diagnostic Images Painful foot Presented by L. Kreel and M.A. Al-Kutoubi Department ofDiagnostic Radiology and Organ Imaging, Chinese University ofHong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong and Radiology Department, St Mary's Hospital, Praed Street, Paddington, London WI, UK The patient A woman of 57, known to have had a mastectomy for breast carcinoma, presented with a painful and slightly swollen left foot. Investigations Radiograph of left foot and isotope bone scan. Protected by copyright. I. l _| ... .. http://pmj.bmj.com/ on September 28, 2021 by guest. Figure 1 The 3rd metacarpal shows marked irregular bone loss, absent cortex and nodular sclerosis. There is diffuse sclerosis of the 2nd and 4th metatarsals with thin Figure 2 The isotope bone scan demonstrates intense periosteal reactions. The tarsus shows marked diffuse loss uptake in the left foot in keeping with active bone of bone density with marginal accentuation but no turnover as occurs with metastases. There is also slight localized bone loss to indicate bone destruction of any of increased isotope uptake at the left greater tuberosity of the tarsal bones. the femur. DIAGNOSTIC IMAGES 175 Postgrad Med J: first published as 10.1136/pgmj.67.784.174 on 1 February 1991. Downloaded from Comment The appearances of proximal tarsal osteopenia, a destructive or lytic lesion in the third metatarsal and diffuse sclerosis ofthe 2nd and 4th metatarsals associated with a minimal periosteal reaction could be due to osteomyelitis but there was no systemic or local evidence of infection.
    [Show full text]
  • Case Report Maxillary and Frontal Bone Simultaneously Involved in Brown Tumor Due to Secondary Hyperparathyroidism in a Hemodialysis Patient
    Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 909150, 4 pages http://dx.doi.org/10.1155/2013/909150 Case Report Maxillary and Frontal Bone Simultaneously Involved in Brown Tumor due to Secondary Hyperparathyroidism in a Hemodialysis Patient Suheil Artul,1 Abdalla Bowirrat,1,2 Mustafa Yassin,1 and Zaher Armaly1 1 EMMS Nazareth, The Nazareth Hospital, Faculty of Medicine Bar-Ilan, Galilee University, 16100 Nazareth, Israel 2 The Nazareth Hospital, 16100 Nazareth, Israel Correspondence should be addressed to Abdalla Bowirrat; [email protected] Received 12 June 2013; Accepted 22 July 2013 Academic Editors: J. Ø. Keller and J. I. Mayordomo Copyright © 2013 Suheil Artul et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brown tumors are rare focal giant cell lesions of the bone caused by primary hyperparathyroidism (HPT). Brown tumor was reported in 1891; it presents as the end-stage findings of HPT. Common involvements are skull and pelvic girdle. We describe a caseof46-year-oldfemalehemodialysispatient,withsecondaryHPTinwhommultiplemasseslesionsoftheleftmaxillarysinus and frontal bone were radiologically suspected to be brown tumor. This unusual manifestation of secondary HPT can be expected to occur with increased longevity of patients with renal failure and illustrates the need to include brown tumor in the differential
    [Show full text]
  • Distal Defect of the Humerus, a Possible Normal Variant: a Case Report Akio Sakamoto* and Shuichi Matsuda
    Sakamoto and Matsuda Journal of Medical Case Reports (2017) 11:241 DOI 10.1186/s13256-017-1395-z CASE REPORT Open Access Distal defect of the humerus, a possible normal variant: a case report Akio Sakamoto* and Shuichi Matsuda Abstract Background: Many normal variants of bones on plain radiographs have been reported. Case presentation: In the current report, a 14-year-old Asian girl noticed an occasional slight elbow pain. She had no traumatic episode. Plain radiographs showed a well-defined osteolytic lesion with a sclerotic rim, which was continuous with the normal subarticular bone in the distal humerus. Magnetic resonance imaging revealed that the defect area seen on the plain radiograph showed low-signal to iso-signal intensity on T1-weighted images and slightly high-signal intensity on T2-weighted fat suppression images. Bone edema was not observed. The association between her elbow pain and the lesion was not conclusive. Conclusions: The findings from the images suggested that the lesion was a normal variant rather than osteochondritis dissecans or a neoplastic lesion, and possibly an anatomical counterpart of a dorsal defect of the patella. Keywords: Humerus, Normal variant, MRI, Case report Background history of trauma. Plain radiographs showed a well- Normal variants can be defined for lesions with atypical defined osteolytic lesion with an osteosclerotic rim in findings, and are normally found in some percentage of the distal humerus. The osteosclerotic rim was absent the population. Normal skeletal variants identified from at the joint periphery, but continued to the subarticu- plain radiographs have been listed in the well-known lar bone.
    [Show full text]
  • Femoral Periosteal Reaction in the Mid-Piece of the Prosthesis: a Potential Predictor of Hip Prosthetic Joint Infection
    Femoral periosteal reaction in the mid-piece of the prosthesis: a potential predictor of hip prosthetic joint infection Zijie Zhang Fujian Medical University Zida Huang First Aliated Hospital of Fujian Medical University Wenbo Li First Aliated Hospital of Fujian Medical University Xinyu Fang First Aliated Hospital of Fujian Medical University Wenming Zhang ( [email protected] ) https://orcid.org/0000-0003-1567-7279 Research article Keywords: Periosteal reaction, Hip prosthetic joint infection, X-ray, Serum inammation index, Diagnosis Posted Date: December 23rd, 2019 DOI: https://doi.org/10.21203/rs.2.19556/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/14 Abstract [Background] Early diagnosis of HPJI is important. Periosteal reaction has been shown to diagnose osteomyelitis and bone tumours; however, research on articial joint infections is not clear. The purpose of this study was to analyse the diagnostic possibility of FPR on X-ray lms for HPJI. [Methods] From January 2017 to June 2019, 105 patients who underwent articial hip joint revision surgery were retrospectively included in the single joint surgery centre. Based on the description by the MSIS in 2013 and exclusion of patients with bone tumour revisions, 66 patients were reviewed and divided into the PJI group and aseptic failure (AF) group. The clinical outcome and radiographic results were examined by two experienced joint surgeons independently on hip X-ray images in all cases. Sensitivity, specicity, PPV and NPV were calculated for FPR in HPJI, and the imaging results were compared with those of serology and bacterial culture.
    [Show full text]
  • Unicameral and Aneurysmal Bone Cyst
    Orthopaedics & Traumatology: Surgery & Research 101 (2015) S119–S127 Available online at ScienceDirect www.sciencedirect.com Review article Bone cysts: Unicameral and aneurysmal bone cyst a,∗,b,c a,d a,e E. Mascard , A. Gomez-Brouchet , K. Lambot a Clinique Arago, 93, boulevard Arago, 75014 Paris, France b Service de chirurgie orthopédique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France c Département de pédiatrie, institut Gustave-Roussy, 94805 Villejuif cedex, France d Service d’anatomopathologie, institut universitaire du cancer de Toulouse oncopole, Toulouse, France e Service de radiologie pédiatrique, hôpital Necker–Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France a r t i c l e i n f o a b s t r a c t Article history: Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and Accepted 12 June 2014 adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily Keywords: the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and Simple bone cyst hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, with- Unicameral bone cyst out translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, Aneurysmal bone cyst excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the Bone tumor fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are dif- Curettage Biopsy ferent.
    [Show full text]
  • Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings1 골경화성 병변에 대한 체계적 접근1
    Pictorial Essay pISSN 1738-2637 / eISSN 2288-2928 J Korean Soc Radiol 2014;71(1):39-48 http://dx.doi.org/10.3348/jksr.2014.71.1.39 Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings1 골경화성 병변에 대한 체계적 접근1 Se Kyoung Park, MD1, In Sook Lee, MD2, Kil Ho Cho, MD3, Jae Hyuck Yi, MD4, Sung Moon Lee, MD5, Sun Joo Lee, MD6, Jong Woon Song, MD7 1Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea 2Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea 3Department of Radiology, Yeungnam University Hospital, Daegu, Korea 4Department of Radiology, Kyungpook National University Hospital, Daegu, Korea 5Department of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea 6Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea 7Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea Sclerotic bone lesions are common, but there are diverse groups of tumors and non-tumorous lesions. Although plain radiograph and computed tomography can Received February 21, 2014; Accepted May 9, 2014 reveal important characteristics of these lesions, diagnosis is often challenging for Corresponding author: In Sook Lee, MD Department of Radiology, Pusan National University radiologists. A systematic approach and familiarity with the imaging features of Hospital, Pusan National University School of Medicine, various sclerotic bone lesions may be greatly helpful for eliminating in the differen- 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. tial diagnosis. This review describes the systematic approach to diagnosing sclerotic Tel.
    [Show full text]
  • Imaging of Focal Sclerotic Bone Lesions Omer Awan, MD, Jim Wu, MD, and Ronald Eisenberg, MD
    This issue of CDR will qualify for 2 ABR Self-Assessment Module SAM (SA-CME) credits. See page 8 for more information. Volume 38 • Number 5 February 28, 2015 Imaging of Focal Sclerotic Bone Lesions Omer Awan, MD, Jim Wu, MD, and Ronald Eisenberg, MD This module meets the American Board of Radiology’s (ABR’s) criteria for self-assessment toward the purpose of fulfilling requirements in the ABR Maintenance of Certification (MOC) program. Please note that in addition to the SA-CME credits, subscribers completing the activity will receive the usual ACCME credits. After participating in this activity, the diagnostic radiologist should be better able to identify and interpret the imaging fi ndings of focal sclerotic bone lesions on radiographs and cross-sectional imaging. CME Category: General Radiology bone lesions (Table 1). The appearance of the sclerotic bone, Subcategory: Musculoskeletal the location of sclerosis, and the patient’s age can be helpful Modality: Radiography in narrowing the differential diagnosis. Trauma Key words: Sclerotic Bone Lesion, Focal Bone Lesion Stress Fracture. A stress fracture can be either a fatigue Focal sclerotic bone lesions are encountered commonly in fracture or insuffi ciency fracture. A fatigue fracture results clini cal practice. The differential diagnosis remains broad from abnormal stress on otherwise normal bone, whereas and includes traumatic, vascular, infectious, neoplastic, met- an insuffi ciency fracture results from normal stress on abnor- abolic, and developmental causes. This article seeks to discuss mal bone. Both lesions typically present with pain that is the various imaging fi ndings in the most commonly encoun- reproducible with activity at the fracture site.
    [Show full text]
  • Nuclear Medicine in Sports Medicine
    REVIEW Nuclear Medicine in Sports Medicine Nuclear medicine imaging has applications in the diagnosis and monitoring of bony and soft tissue sports-related injuries. Skeletal scintigraphy may localize traumatic disorders. Dynamic studies show changes in many conditions such as bone stress, fracture, periosteal reaction, osteochondritis dissecans, enthesopathy, osteonecrosis, complex regional pain syndrome, and degenerative change. In addition, special views can be used in fracture, periosteal reaction, osteochondritis dissecans, enthesopathy and abnormalities in the spine. Magnification techniques have also been described. Furthermore, pinhole imaging can detect fracture, osteonecrosis, and impingement syndromes. SPECT imaging may give valuable information in the detection of fracture, avulsion injury, joint injuries, osteonecrosis, back pain, and rhabdomyolysis. SPECT/CT provides precise information in osteochondritis dissecans, enthesopathy, joint injuries, impingement syndromes and abnormalities in the spine. Lymphoscintigraphy is a diagnostic tool. There is interest in PET studies at traumatic brain injury and at the neurotransmitter level. PET/CT can be useful in selected athletic injuries. KEYWORDS: scintigraphy ■ special views ■ pinhole views ■ SPECT ■ SPECT/CT ■ PET ■ PET/CT ■ sports injuries Bone stress metatarsal, three-phase skeletal scintigraphy can Margarita Pagou* & give objective evidence of the exact site of the Vasileios Poulantzas Bone stress can eventually lead to the fracturing abnormality [4]. of bone. A schema (FIGURE 1) has been Asklipios Medical Diagnostic Centre, proposed to explain the changes in bone in Fracture Athens, Greece response to repetitive stress and the occurrence of positive radionuclide images and negative Stress fracture *Author for correspondence : radiographs in the same patient with bone stress [email protected] [1]. Stress fracture is an overuse injury caused by muscle forces combined with bending and Most femoral stress injuries are associated with impact forces acting on the bone, which has not running [2].
    [Show full text]