Ebook Challenging cases in musculoskeletal imaging: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Challenging cases in musculoskeletal imaging: Part 2
Ebook Challenging cases in musculoskeletal imaging: Part 2
Sh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2estion: A 21-year-old man was examined radiologicalfy for multiple injuries. A radiograph of the left clavicle showed a defect in the inferior border (list lateral to the head of the clavicle (the medial or sternal end of the clavicle). Before ordering biopsy, the orthopedist wanted to know what the Ebook Challenging cases in musculoskeletal imaging: Part 2 delect might represent.Radiologic FindingsA semicircular defect is visible in the inferior border of the clavicle just lateral tn rhe clavicular headEbook Challenging cases in musculoskeletal imaging: Part 2
(see arrows in ► Fig. 5.1 a). A subsequent whole-body bone scan (► Fig. 5.1 bi appeals normal. Slightly increased uptake in rhe manubriosternal syn-cSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2cans, which are not reproduced here because the case can be solved without them (see Assignment to a Possible Basic Entity helow). A similar hut very subtle finding was also noted on the contralateral side.Pathoanatomic Background of the FindingsThe tissue structure replacing rhe bone is not associa Ebook Challenging cases in musculoskeletal imaging: Part 2ted with increased bone turnover (negative bune scaiij-llidt IS, it does not incite a perifocal reaction, and it dnes nor form a matrix (e.g„ bone, caEbook Challenging cases in musculoskeletal imaging: Part 2
rtilage, ossifying connective tissue).scan suggests a normal variant. When we consider its location (see above), it is reasonable to assume that we arSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2ic differential diagnosis.Synopsis and DiscussionThe apparent defect in the undersurface of the clavicle, just lateral to the medial end uf the cldvicule (clavicular head), IS called a ■•ligament groove" in the literature and corresponds to the attachment of the costoclavicular ligament.17 This atta Ebook Challenging cases in musculoskeletal imaging: Part 2chment site generally appears radiographically ds d more or less prnnnunced irregularity in the contour of rhe hone. In extreme cases it forms dll dilEbook Challenging cases in musculoskeletal imaging: Part 2
udl groove and appears ds d well-defined defect, especially when the shoulder girdle has been subjected lu particularly high mechanical stresses. TinsSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2ake on rhe hone scan. Similar findings are known to occur in the femoral neck (see Case 69 and Case 73). the iscliid. al the pectnralis attachment (see images in Case 102. Case 10?. and Case 104). and al other sites.Final Diagnosis1 igamenr groove at the attachment of the costoclavicular ligament. c Ebook Challenging cases in musculoskeletal imaging: Part 2onsidered a normal variant.CommentsI he key to the correct interpretation of a radiologic finding often lies in its location.Assignment to a PossibleEbook Challenging cases in musculoskeletal imaging: Part 2
Basic Entity► Normal variant or malformation? Yes. The very fad that the defect was detected incidentally and was negative on rhe bone185Shoulder GirdSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2her wise healthy, felt a lump in her left supraclavicular fossa. She slated that many years ago she had suffered head and neck sprains in a motor vehicle accident but could recall no further details. The radiologist wanted to know the origin of the finger-shaped structure at the junction of the neck Ebook Challenging cases in musculoskeletal imaging: Part 2 and shoulder. Malformation?Radiologic FindingsThe radiograph in ► Fig. 52 shows a finger-shaped bony structure lliat follows the lateral border of thEbook Challenging cases in musculoskeletal imaging: Part 2
e trapezius muscle and widens from above downward in a trapezoidal pattern. A kind of pseudai thiosis IS noted al the center of the slrucluie. The acrSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2ructure follows rhe lateral border of the trapezius muscle. The peripheral end UÍ the left clavicle has vanished. In terms of vascular anatomy, this area represents a terminal vascular bed with a critical bluod supply. The finger-shaped ossification on rhe lateral side of trapezius appears connected Ebook Challenging cases in musculoskeletal imaging: Part 2 to die lateral cuff-sliaped structure by die claviculai attachment of rhe trapezius muscle.Pathoanatomic Background of the FindingsThe oblong structuEbook Challenging cases in musculoskeletal imaging: Part 2
re at rhe lateral junction of the neck and shoulder is composed of solid bone with a cortex and medullary cavity, causing it to resemble a finger. TheSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical que Ebook Challenging cases in musculoskeletal imaging: Part 2n? A kind of accessory bone called the OS omoveitebrale (Latin om = shoulder) located at the junction of the shoulder and lateral neck has been described in the literature.’7 It is known to occur in Klippel Fell syndrome. The finger-shaped bony structure could very well be an OS omo-vercebrale. but Ebook Challenging cases in musculoskeletal imaging: Part 2the cervical vertebrae that appear ill the radio graph do not show any gross signs of Klippel-Feil syndrome such as blocking. Could this be due to traEbook Challenging cases in musculoskeletal imaging: Part 2
uma?Sh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical queSh5 Shoulder Girdle and Thoracic Cage5.1 ClavicleCase 78 (► Fig. 5.1)Case description•Referring physician: orthopedist.•Prior history and clinical queGọi ngay
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