DX: Asymmetric Ischiopubic Synchondrosis (van Neck-Odelberg disease)

This is an important variant that we as radiologists have to take in consideration. The ischiopubic synchondrosis (IPS) is the junction between the inferior ischial and pubic rami and is principally composed of hyaline cartilage. Is a temporal joint occurring in childhood prior to fusion of the ischial and pubic bones. With skeletal maturation, like all synchondroses, it becomes thinner and then obliterates, either due to bony union or synostosis.

Here is the spot image:

There is an expansile lesion of the inferior ischial and pubic rami that resembles a lytic bone mass (chondroid matrix). But in this group age, before a bone neoplasm arrises as a differential we have to discard first normal variants or infectious ethiology. Osteomyelitis is a good possibility but there is no history of previous limb or skin infection. Neither there's no history of malnourishment that can induce such infection. 

Therefore, IPS is our main consideration. It can be asymmetric also. But why pain?...if pain presents, we called it Van Neck-Odelberg disease and treat it as a growing pain. Also is good to consider that this disease has correlation with foot dominance.

Here are some examples in literature:

http://www.ijri.org/article.asp?issn=0971-3026%3Byear%3D2011%3Bvolume%3D21%3Bissue%3D2%3Bspage%3D107%3Bepage%3D110%3Baulast%3DMacarini
http://uiortho.com/ioj/2010/08cases.pdf
http://www.virtualpediatrichospital.org/providers/PAP/MSDiseases/IschiopubSynchon.shtml
http://www.ajronline.org/content/182/2/361.full.pdf+html


Thanks for your participation in FB groups.

Until next year!!

CASE 29: 5 y/o male with left hip pain

An infant with chronic left hip pain..Pain was mild and he had no relevant history to our concern.

Differentials?

Later on I'll post the conclusion.

DX: Lumbar spine duplication

Remember the past post?

This case don't needed further description. I pressume that is very clear that there are 2 parallel lumbar vertebraes semideveloped, each one with its own pedicle, vertebral body and laminae.


Patient had a visible, ulcerated open spine defect. CT is great for evaluation of bone structures but we need MRI to clearly define this pathology because it can clearly show the spinal chord and conus medularis, dural sac and meninges. This case was unknown to me, at first I thought maybe it is a severe  form of diastematomyelia (two hemichords?). One thing is a fact, that there is a duplication of almost 3 lumbar vertebraes and latter fusion at sacrum level. This remarcable defect is rare and exceptional.

It i typically associated with severe neurologic abnormalities (dicephalus, myelomeningocele) or gastrointestinal abnormalities (omphalocele, neurenteric fistulas).

The pathologic variants of split cord malformation range from a fibrous septum only partially splitting the cord and acting as a tether point within a single dural sac, at the mild end of the spectrum to gross vertebral anomalies with partial spine duplication and tethering at a fibro-osseous midline mass often associated with a lipomeningomyelocele or neurenteric cyst at the severe end.

For further information please reffer to links below.

Thank you all COBRAns for your participation on FB group.

• http://link.springer.com/content/pdf/10.1007%2FPL00007301
• http://www.ajnr.org/content/25/5/895.full.pdf+html
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647508/pdf/i1079-0268-32-1-99.pdf
• http://www.ajnr.org/content/25/5/895.full.pdf
• http://www.experts.scival.com/uic/pubDetail.asp?t=pm&id=9516710&n=Benjamin+A+Goldberg&u_id=767

CASE 28: 3 month old female patient with lumbar neural placode

This is a depictive case..

A newborn ongoing a CT scan due to open lumbar spine defect (Myelomeningocele).

Differentials??..feel free to comment

DX: Chondroblastoma of the hand

Ok sorry for the delay. Here is the reason:

I knew that this patient went to ressection of the hand mass because I found this image:

Later on, I compared with previous hand x-ray prior to biopsy 11 years ago.

We see here an expansile mass with predominantly chondroid matrix. Bening appeareance, but age favors malignancy in bone tumors. So a biopsy was conducted and it revealed : Chondroblastoma

Patient was given a conservative treatment but 10 years later the mass continued to cause pain. This is the radiography control.

Pathological specimen (seen above) revealed: Osteochondroma.

That was the issue. I went to pathologist and the Department decided to conduce a revision of the case. And I was part of the discussion. Imaging findings are clearly narrowing the scope of differentials to a chondroid, benign, slow growing mass with no soft tissue involvement and some diffuse calcifications. STIR and T2 sequences are useful to show the hyperintensity of the lesion due to cartilaginous tissue wich is rich in water content. They reviewed the biopsy with the specimen and concluded that it is a Chondroblastoma.

Either way, this is still a rare lesion in the hand and more rarer in this group age (>50y).

Chondroblastomas most frequently arise in the epiphyses of long bones, with 70% occurring in the humerus (most frequent), femur and tibia 9. ~ 10% are found in the hands and feet wich is this case.

They are seen as well defined lytic lesions, with either smooth or lobulated margins with a thin sclerotic rim, arising in the epiphysis or apophysis of long tubular bone such as the femur, humerus, or tibia. Internal calcifications can be seen in up to 40 - 60% of cases 7,9. A joint effusion is seen in ~1/3 of patients. They range in size from 1 - 10cm, with most being 3 - 4cm at diagnosis.

Approximately 92% of patients presenting with chondroblastoma are younger than 30 years. However, chondroblastomas have been reported to arise in patients as young as 2 years and as old as 83 years. In several large series, most patients were diagnosed in the second decade of life.

Thank you for the patience in this case. Hope is useful.

CASE 27: 64 y/o male with hand bump

Ok here goes this next case.

A 64 year old male with mildly painful progressive swelling in left hand wich was originally suspected to be a cyst, but ultrasound proved it wrong. Unfortunately don't have US images because it was made in another clinic, but the recommendation was to order an MR of the hand. No history of trauma or infection to our concern.

Here are the relevant images:

 STIR CORONAL

 STIR AXIAL

 T1 CORONAL

 T1 POST GAD

 T2 CORONAL

T2 AXIAL

Differentials?

Later I'll post the conclusion of this biopsy proven case.