Gerhard Bock

1
1991-1992

• Gerhard Bock
• Pamela Isaacs
• Joseph Spaeth
• Megan McAndless
• Michael Recht
• Guo-Shu Huang
• Yang Hee Park
• Enrique Bosch
• Gerhard Boch

2
Gerhard Bock

• 22 year old male
• 6 month history of finger pain and swelling
• No history of trauma

3
22M 6 month history of finger pain and
swellingNo history of trauma
4
22M 6 month history of finger pain and
swellingNo history of trauma
5
22M 6 month history of finger pain and
swellingNo history of trauma
6
22M 6 month history of finger pain and
swellingNo history of trauma
7
Findings

• Radiograph
• Soft tissue swelling
• Oval radiolucent lesion in proximal phalanx with
  suggestion of cortical thickening/sclerosis
• Possible internal density
• MRI
• Soft tissue edema around phalanx
• Eccentric lucency with central area of decreased
  signal
• CT with reformat
• Confirms lucency with central calcified density
• Soft tissue swelling about phalanx

8
Differential dx

• Osteiod osteoma
• Brodies abcess

9
Diagnosis

• Osteiod osteoma
• 20 occur in hands or feet
• Usually proximal phalanx or metacarpal
• Malesgtfemales 31 usual age range 7-25yrs
• Variable appearance in hands
• If cortical prominent periostitis
• If subperiosteal scalloping of bone
• If cancellous partially or totally calcified
• Prominent soft tissue swelling simulating
  infection or arthritis
• Painless lesions appear to be more frequent in
  phalanges