What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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Findings Radiographs demonstrate a subtle area of soft tissue swelling which on the MRI shows more conspicuous soft tissue swelling about the PIP with intermediate to high PD and IR tissue. This shows indolent remodeling of the bone indicating a more long standing process. The bone scan showed focal areas of increased uptake of the right acetabulum and ischium that correlate to masses seen on the subsequent MRI with low T1 and high T2 signal. Chest CT at that time demonstrates a marked amount of mediastinal and hilar lymphadenopathy. The CT study for biopsy purposes demonstrates a paucity of findings at the area of interest of the right iliac bone. The absence of findings on the CT demonstrates at times the difficulty in doing a CT biopsy and the need to use anatomic landmarks to help obtain an appropriate specimen to render a diagnosis. Subsequent radiograph 5 years later shows no masses where as MRI demonstrates multiple masses that have increased in number as compared to the prior study with again low T1 and high T2 signal intensity.
What’s the Diagnosis – Case 101
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What’s the Diagnosis – Case 101
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Diagnosis: Sarcoid Sarcoid is a poorly understood granulomatous disorder that can involve every organ system of the body. It is stated that anywhere from 1 to nearly 15% of people that have sarcoid will show bony manifestations. The bone, skin, soft tissue (particularly periarticular), joints, and muscle can all be affected by this disease. In the small bones of the hands and feet there is a classically described reticular or lace like pattern seen but this is not present in this patient. There can also be large cystic lesions, sclerotic lesions, or a conglomeration of small cystic lesions. In the larger bones as seen here there are frequently focal masses but a more infiltrative or diffuse pattern can be seen. On MRI, the soft tissue masses are frequently described as low T1 and high T2 but the T2 can be somewhat variable in nature. Similarly, the large lesions of the bone are typically high on T2 but may be variable in nature. The signal intensity is thought to relate in some degree to the activity of the process. Although multiple osseous lesions should always raise the suspicion of metastatic disease, this case highlights that other etiologies always have to be thought about as alternative diagnoses.
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References Musculoskeletal sarcoidosis: spectrum of appearances at MR imaging Moore SL1, Teirstein AE. Radiographics. 2003 Nov-Dec;23(6):1389-99. Radiographic, angiographic, and radionuclide manifestations of osseous sarcoidosis. Yaghmai Issa MD. Radiographics 1983 Sept. Vol. 3 No. 3 Osseous sarcoidosis: a case of evolving MR appearances correlating with clinical symptoms. Niederhauser BD, Hohberger LA, Shon W, Howe BM. Skeletal Radiol. 2014 Jan;43(1):79-83. doi: 10.1007/s00256-013-1693-5. Epub 2013 Jul 27.
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