X-Ray Case Studies - PowerPoint PPT Presentation

Loading...

PPT – X-Ray Case Studies PowerPoint presentation | free to download - id: 844dd9-NTc2M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

X-Ray Case Studies

Description:

X-Ray Case Studies Jim Messerly D.O. Case #1 History 17 year-old female ballet dancer with snapping sensation along the medial aspect of her right knee when extending ... – PowerPoint PPT presentation

Number of Views:65
Avg rating:3.0/5.0
Slides: 61
Provided by: jmesserly
Learn more at: http://www.waops.org
Category:
Tags: case | knee | ray | studies | valgus

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: X-Ray Case Studies


1
X-Ray Case Studies
  • Jim Messerly D.O.

2
Case 1 History
  • 17 year-old female ballet dancer with snapping
    sensation along the medial aspect of her right
    knee when extending her right knee during jumps.

3
Case 1 Physical Exam
  • Physical exam showed no evidence of effusion.
    There was full range of motion of the right knee
    with reproducible popping of the posterior medial
    hamstring with flexion and extension which was
    minimally painful. No joint line tenderness.
    McMurrays testing was negative.

4
Case 1 X-Rays
5
Case 1 X-Rays
6
Case 1 Diagnosis ?
  • A. Stress fracture
  • B. Osteoid Osteoma
  • C. Osteochondroma
  • D. Osteosarcoma

7
Osteochondroma
  • Most common benign tumor of bone.
  • Outgrowth of bone usually located in the
    metaphysis projecting away from the joint.
  • Malignant transformation rare except in
    Hereditary Multiple Exostosis (HME).
  • Usually left alone unless interferes with
    surrounding muscles, tendons or nerves or
    interferes with activity- then can be resected.

8
Case 2 History
  • 16 year-old male football player who developed
    sudden onset of severe left shoulder pain while
    reaching with his left upper extremity during a
    football drill. There was no contact. He
    complained of pain in the posterior aspect of his
    left shoulder and proximal left arm. He was
    evaluated by an athletic trainer and was placed
    in a sling.

9
Case 2 Physical Exam
  • The patient was in obvious discomfort due to his
    left shoulder pain. There was a questionable
    left shoulder effusion. Active flexion and
    abduction were limited to only 15 because of
    severe pain. There was severe pain with any
    attempts of resisted internal or external
    rotation of the left shoulder.

10
Case 2 X-rays
11
Case 2 X-rays
12
Case 2 Diagnosis?
  1. Aneurysmal Bone Cyst
  2. Metastatic lesion
  3. Fibrous Dysplasia
  4. Unicameral Bone Cyst

13
Unicameral Bone Cyst
  • Usually found in the proximal humerus, but also
    can be found in the proximal femur or calcaneus.
  • X-rays show well-defined lytic lesion with thin
    sclerotic margin with no periosteal reaction.
  • Pathologic fracture may allow healing of cyst.
  • Injection of steroid, bone marrow, demineralized
    bone or surgical treatment may be needed.

14
Case 3 History
  • 16-year-old male with 6-9 month history of right
    elbow pain and lack of full extension. The
    patient is a snowmobile racer and wondered if he
    may have injured the right elbow during one of
    his many wipe outs during snowmobile races. Three
    days prior, he was lifting a heavy box and had a
    forceful extension of his left elbow with
    associated increased pain and some swelling.

15
Case 3 Physical Exam
  • There was a moderate right elbow effusion. Range
    of motion was 40 to 105 with pain at end range
    motion. Moderate tenderness of the medial joint
    line. Ligaments were stable with some pain with
    valgus stress.

16
Case 3 X-rays
17
Case 3 X-Rays
18
Case 3 MRI
19
Case 3 Diagnosis?
  1. Osteoid Osteoma
  2. Fibrous Dysplasia
  3. Aneurysmal Bone Cyst
  4. Chondrosarcoma

20
Aneurysmal Bone Cyst
  • Usually located in long bones or spine in
    patients less than age 20.
  • X-rays show eccentrically located metaphyseal
    lytic lesion.
  • Typical complaints are swelling and pain which
    usually follows an injury.
  • Biopsy is frequently required to rule out
    malignant lesion.
  • Treatment is by curettage with bone grafting.

21
Case 4
  • 20 year-old college female with anterior right
    leg pain for the past five months. The patient
    had been using the Stair Master and jogging for
    up to an hour a day during the summer. When her
    college classes started in the fall, she
    continued to workout in spite of the pain, but
    had been off running for the past two weeks
    without improvement of her pain.

22
Case 4 Physical Exam
  • There was mild firm swelling over the anterior
    aspect of the distal third of the right tibial
    shaft. Moderate tenderness to palpation and
    percussion. Full range of motion of the right
    knee and ankle. Arches of the feet were
    minimally pronated.

23
Case 4 X-Rays
24
Case 4 X-Rays
25
Case 4 CT Scan
26
Case 4 Diagnosis ?
  1. Osteoid Osteoma
  2. Fibrous Cortical Defect
  3. Healing Stress Fracture
  4. Hemangioma

27
Osteoid Osteoma
  • Frequently causes deep aching pain which is worse
    at night.
  • Pain is frequently relieved by aspirin/NSAIDs.
  • X-ray/CT shows radiolucent nidus surrounded by
    reactive sclerotic bone.
  • Treatment- Waiting, Radiofrequency ablation or
    excision.

28
Case 5 History
  • 13-year-old male with one-year history of
    thoracic spine pain which had been worsening over
    the past two months. Severe night pain. The
    patient had been unable to participate in
    basketball because of his pain. Chiropractic care
    was not helpful for his pain. Previous x-rays had
    shown evidence of a moderate thoracic spine
    scoliosis.

29
Case 5 Physical Exam
  • Moderate right-sided thoracic spine scoliosis.
    Moderate tenderness on palpation from T6 to T10.
    Minimal restriction with flexion and extension of
    the thoracic spine. Lower extremity neurological
    exam was unremarkable.

30
Case 5 X-Rays
31
Case 5 MRI
32
Case 5 CT Sagittal
33
Case 5 CT Axial
34
Case 5 Diagnosis?
  1. Osteoid Osteoma
  2. Osteoblastoma
  3. Giant Cell Tumor
  4. Hemangioma

35
Osteoid Osteoma
  • Small round focus-nidus
  • Radiofrequency ablation is difficult when in the
    spine and resection may be best approach.

36
Case 6 History
  • 17-year-old male with complaint of right knee
    pain which had been present for the past 4-5
    months. He noted some right knee pain after
    playing basketball during the summer. He denied
    catching, locking or giving way. There was no
    significant swelling. He had been treating with
    physical therapy without significant improvement.
    He was currently participating on the curling
    team.

37
Case 6 Physical Exam
  • No evidence of right knee effusion. Mild soft
    tissue swelling in the region of the proximal
    tibia both medially and laterally with mild
    tenderness on palpation. Mild generalized knee
    pain with forced extension. There was full
    flexion without pain. Ligaments were stable.
    Mild lateral joint line tenderness. McMurrays
    testing was negative.

38
Case 6 X-Rays
39
Case 6 X-Rays
40
Case 6 X-Rays
41
Case 6 MRI
42
Case 6 Diagnosis?
  1. Stress fracture
  2. Osteosarcoma
  3. Chondrosarcoma
  4. Im not sure, but it sure looks bad

43
Osteosarcoma
  • Most common malignant bone tumor in the pediatric
    population.
  • Most common location is in the tibia, femur or
    humerus.
  • Frequently causes bone pain.
  • X-rays frequently show combined lytic and
    sclerotic changes.
  • Treatment involves chemotherapy, possible
    radiation followed by surgery.

44
Case 7 History
  • 60 year-old female with complaint of right knee
    pain which was worse over the past few weeks when
    she tried to increase her walking activities.
    She described anterior medial and lateral right
    knee pain. Her pain was worse with prolonged
    standing, driving or when walking stairs. There
    was no catching, locking or giving way. No
    swelling.

45
Case 7 Physical Exam
  • There was a trace effusion of the right knee.
    There was full range of motion with moderate
    patella crepitus. Mild patellar facet tenderness
    to palpation. Ligaments were stable. Mild
    medial joint line tenderness.

46
Case 7 X-Rays
47
Case 7 X-Rays
48
Case 7 X-Rays
49
Case 7 Diagnosis?
  1. Stress fracture
  2. Osteosarcoma
  3. Enchondroma
  4. Mild to moderate patellofemoral osteoarthritis
    with patellofemoral pain

50
Enchondroma
  • Benign cartilage lesion centrally located within
    bones that can occur at any age.
  • Usually asymptomatic.
  • Frequently found in the bones of the hand.
  • X-ray follow-up recommended to document stability
    because occasionally difficult to distinguish
    enchondroma from low-grade chondrosarcoma

51
Chondrosarcoma
52
Case 8 History and Exam
  • History 27 year-old female with complaint of
    left knee pain and swelling for two months. No
    history of injury. She describes lateral left
    knee pain with associated near giving way
    episodes. She frequently limps because of her
    left knee pain. She denies fevers, chills or
    night sweats.
  • Exam The patient does walk with a limp favoring
    her left knee. There was a trace effusion of the
    left knee. Mild anterior lateral left knee pain
    with full flexion. Ligaments were stable.
    Moderate lateral joint line tenderness which was
    worse with McMurray testing.

53
Case 8 X-Rays
54
Case 8 X-Rays
55
Case 8 X-Rays
56
Case 8 MRI
57
Case 8 MRI
58
Case 8 Diagnosis?
  1. Stress fracture
  2. Fibrous cortical defect
  3. Giant cell tumor
  4. I dont know, but it sure looks bad

59
I dont know, but is sure looks bad
  • Referred to university center
  • Biopsy shows leiomyosarcoma
  • Treated with resection and knee replacement
    surgery

60
Thank you
About PowerShow.com