Case 1 - A 40-year-old woman with a history of lymphoma in remission presents with left hip pain. Imaging shows abnormalities at the left anterior iliac crest. A companion case involves a 43-year-old woman with pain at the right anterior iliac crest. Case 2 - A 27-year-old runner developed weakness and edema over 4 months. Labs show peripheral eosinophilia. MRI shows abnormalities of the thighs. Case 3 - A 32-year-old man noted a firm right shoulder mass. Imaging shows a scapular mass and a companion case of a more common presentation of the same entity in the thumb. Case 4 - An 84-year-old man

1. Case 1

2. History and Physical
• 40 y.o. woman
• History of lymphoma dx’d 2 yrs prior, now in
remission
• Now with 2 months severe left “hip” pain
• Tenderness to palpation over left anterior iliac
crest

3. Coronal T1 Axial Fat Sat T2 (STIR)

4. Post-Gad Axial Fat Sat T1
Post-Gad Coronal
Fat Sat T1

5. PET CT from 4 months
before MRI;
Negative for lymphoma

6. Companion Case – Different Patient
43 yo woman, very athletic
focal pain at right anterior superior iliac
crest
Coronal Fat Sat T2

7. Axial T1
Companion
Case (cont.) Axial Fat Sat T2

8. Case 2

9. History
• 27 yo woman, runner (~16 miles/week)
• No relevant PMH or family hx
• Over 4 months, developed b/l lower extremity
soreness and subjective weakness that
progressed to involve both upper extremities
• Sx became significantly worse in month 4 and
were accompanied by 1+ pitting edema of the
lower extremities, with less pronounced swelling
of the upper extremities and abdomen

10. • Work-up by PCP and rheumatology
– CXR, echo – negative
– ESR, CRP, ANA, RF, Lyme titer, all specific
serologies – negative
– “Skin felt overall thicker in lower extremities”
– No erythema, warmth, rash, synovitis, no neuro
or other physical exam findings

11. Labs
– CK 54 (normal; range 29-201)
– WBC 11 (top normal; range 4-11)
– Differential showed peripheral eosinophilia
• Neutrophils 41% (range 50-70)
• Lymphocytes 13% (range 18-42)
• Monocytes 2% (range 2-11)
• Eosinophils 44% (range 0-4)
• Basophils 0.5% (range 0-2)
– Aldolase 22.7 (increased; range <8.1)
– Platelets 453k (slightly increased; range 150-440k)

12. Bilateral Thigh MRI
Axial Fat Sat T2Axial Fat Sat T1

13. Case 3

14. History
• 32 y.o. man, otherwise healthy, office worker
• Noted firm, somewhat tender mass along
posterior right (dominant) shoulder 1 month prior
• Did not cause shoulder pain or affect range of
motion
• No other masses
• Physical Exam – firm, well-circumscribed non-
mobile mass that was rigidly attached to the
scapula

16. Sagittal Reformat
Axial MDCT

17. Sagittal Fat Sat T2Sagittal T1

18. Companion Case
more common presentation of the same
entity that is seen in the scapula

19. History and Physical
• 56 y.o. right-hand dominant teacher
• Mass in left thumb x 1 year, gradually enlarging
• No hx of trauma
• Discomfort when bangs against things and occasionally
wakes her at night
• No other masses
• No relevant PMH or family hx
• Physical exam - bony prominence over the dorsal
aspect of the MP joint, minimally tender to palpation.
Significant limitation in motion at the MP joint.

21. Axial MDCT Sagittal Reformats

22. Axial Fat Sat T2
markers

23. Case 4

24. History and Physical
• 84-year-old man
• Presents with progressive difficulty walking
and clumsiness and weakness in
both upper extremities
• Recent fall with neck pain
• Myelopathic on physical exam
• PMH: MI, renal insufficiency, gout

25. Elderly male with fall and neck pain
Radiographs

26. Elderly male with fall and neck pain
Sagittal T1 Sagittal T2

27. Elderly male with fall and neck pain
Sagittal Reformats

28. Elderly male with fall and neck pain
Sagittal Reformats

29. Elderly male with fall and neck pain
Axial MDCT

30. Elderly male with fall and neck pain
Axial MDCT