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Radiology Rounds: Elderly male with leg pain
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Radiology Rounds: Elderly male with leg pain

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Radiology Rounds: Elderly male with leg pain

Radiology Rounds: Elderly male with leg pain

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Radiology Rounds: Elderly male with leg pain Presentation Transcript

  • 1. Elderly male with leg pain Laura Avery, MD Massachusetts General Hospital Harvard Medical School Boston, MA, USA
  • 2.  
  • 3. What disease process if affecting the femur?
    • Paget’s disease
    • What adjectives do you want to use to describe the finding?
      • cortical thickening
      • Trabecular thickening
      • Increased size of bone
  • 4. Trabecular thickening cortical thickening Increased size of bone
  • 5.
    • What important finding is present?
  • 6. Incomplete fracture
  • 7. Patient returned with increased pain “ Banana fracture" = tiny horizontal cortical infractions (“Looser lines”) on convex surfaces of lower extremity long bones (lateral bowing of femur, anterior bowing of tibia)
  • 8. Paget’s Disease
    • The radiologic appearance of Paget's disease of the long bone reflects the pathologic stages of the disease:
      • (1) destructive or active,
      • (2) combined destructive and proliferative, and
      • (3) sclerotic. Paget's disease of the long bones begins at one end of the bone (the shaft of the tibia may occasionally be involved by itself).
    • Complications of Paget's disease are insufficiency and true fractures;
    • sarcoma is a rare complication.
    • Paget's disease does not require follow-up imaging unless complications occur.
  • 9. Radiology slang
    • "Cotton wool" appearance represents mixed lytic and blastic pattern of thickened calvarium (later stage)
    • "Candle flame" or "blade of grass" pattern of lysis is the advancing tip of V-shaped lytic defect in diaphysis of long bone originating in subarticular site
    • "Picture-frame vertebra" mimics bone-within-bone appearance
      • Enlarged vertebral body with reinforced peripheral trabeculae and more lucent center, typically in lumbar spine
    • "Ivory vertebra" is a blastic vertebra with increased density
  • 10.