2001 2002 Sandip Biswal Nancy Chege Jerry Dwek

2001 -2002 • • • Sandip Biswal Nancy Chege Jerry Dwek John Felt Todd Guinn Michael Huk Viviane Khoury Mohammed Munshi Steven Ross Steven Sorenson • • • • Cagla (Chala) Tarhan Michelle Wessely Marcelo de Abreu Greg Antonio Iwan Van Breuseghem Jae-Hyun Cho Kullanut Prompitaksa Leopoldo Gigena Luis Mendes Marcio Vicentini Min-Hee Lee Rogerio Ulson Soon-Tae Kwon Jee-Young Kim

Mohammed Munshi • 40 year old female with pain in upper arm

40 year old female with pain in upper arm

40 year old female with pain in upper arm

40 year old female with pain in upper arm

40 year old female with pain in upper arm

40 year old female with pain in upper arm

40 year old female with pain in upper arm

Postyear Gad Axold T 1 fatfemale sat 40 with pain in upper arm

40 year old female with pain in upper arm Post Gad Ax T 1 fat sat Ax T 2

Diagnosis • Mazabraud’s Syndrome

Discussion • Polyostotic fibrous dysplasia (20 -30% of cases with fibrous dysplasia) • More frequently involves the skull, face pelvis and shoulder girdle • Mazabraud’s Syndrome (Fibrous dysplasia + intramuscular myxomas, commonly in thigh, buttock and pelvis) • Mc. Cune-Albright Syndrome (Fibrous dysplasia + precocious puberty, cutaneous pigmentation)

Mohammed Munshi • 29 year old male with a seizure

29 year old male with a seizure Non-Contrast CT

29 year old male with a seizure Post Gad Ax T 1

29 year old male with a seizure

Further History • 3 month Hx of enlarging lower leg mass

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Sag T 1

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Cor T 2 Fat sat

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Post Gad Cor T 1 Fat sat

29 year old male with a seizure. 3 month Hx of enlarging lower leg mass Post Gad Ax T 1 Fat sat

Diagnosis • Extraskeletal Ewing’s Sarcoma (biopsy proven) with brain , chest and bone metastases

Discussion • DDx of soft tissue tumors with brain mets • • • Rhabdomyosarcoma Extraskeletal Ewing’s Sarcoma Alveolar Soft part Sarcoma

Viviane Khoury University of Montreal, Quebec, Canada • • • 60 y. o. male History of recent acute pancreatitis Multifocal bone pain (case 2 – courtesy of my colleague Dr. E. Cardinal)

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain Bone scintigraphy (99 Tc)

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain Radiographs

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain

60 y. o. male. History of recent acute pancreatitis. Multifocal bone pain • At surgical exploration of forearm and tibias: “purulent material” • Patient is afebrile • Improved without antibiotics

MRI lower legs (T 1 and STIR)

MRI elbow and forearm (ax T 1 and STIR)

Imaging Findings • Bone scan: Multifocal areas of uptake, diaphyseal and periarticular • Radiographs: osteopenia, permeative pattern of involvment in long bones and phalanges • MRI: Typical appearance of extensive osteonecrosis in tibias and ulnas. However, there also areas of bony destruction (distal tibial diaphysis, ulnar shaft)

Diagnosis: Fat Necrosis 2 o pancreatic disease with medullary fat necrosis Pancreatic disorders (ca, pancreatitis) can be complicated by following: • fat necrosis at multiple distant sites • S/c skin nodules • Polyarthritis • Medullar fat necrosis • Lytic bone lesions may simulate osteomyelitis (long bones, hands, feet) • Excess circulating lipase with autodigestion of fat deposits at distal sites? Source: Baby Resnick, p. 312

Viviane Khoury University of Montreal, Quebec, Canada • 70 y. o. female • Recent left ankle fracture, now c/o mild left knee pain

70 y. o. female. Recent left ankle fracture, now c/o mild left knee pain Knee radiographs

70 y. o. female. Recent left ankle fracture, now c/o mild left knee pain CT

70 y. o. female. Recent left ankle fracture, now c/o mild left knee pain MRI (ax and sag T 1)

70 y. o. female. Recent left ankle fracture, now c/o mild left knee pain MRI (ax STIR and cor GRE)

70 y. o. female. Recent left ankle fracture, now c/o mild left knee pain MR (cor, sag, ax FS T 1 post gado)

Radiographs and CT Findings • Exophytic, lobulated, densely ossified mass at posteromedial aspect of distal femoral diametaphysis • Intramedullary sclerotic foci in medial femoral condyle with spiculated margins • No contiguity with medullary bone • No aggressive features

MR Findings • Exophytic ossified mass is hypointense on all sequences, as are intramedullary foci • Surrounding thin rim of enhancing soft tissue (of variable thickness) • No large soft tissue mass

Diagnosis • Melorrheostosis (atypical, with largely mineralized exophytic component) • No intervention; f/u radiograph 1 year later unchanged • Ddx: • • Not osteochondroma due to lack of medullary contiguity Not osteosarcoma/other sarcoma due to lack of aggressive features Judkiewicz AM, et al. Advanced imaging of melorheostosis with emphasis on MRI. Skeletal Radiol. 2001 Aug; 30(8): 447 -53.