What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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Findings In the two month interval on the radiographs there is a shocking change from an absence of findings to a marked degree of radiolucency of the bones about the knee joint, a very aggressive periosteal reaction with a Codman’s triangle, a subtle area of increased sclerosis of the distal/lateral femur, and an effacement of a lateral fat plane about the distal femur. On the MRI, there is an aggressive, heterogeneously enhancing mass that extends into the soft tissue. There is a surrounding periosteal reaction, a marked amount of surrounding edema, and areas of persistent low signal in keeping with areas of surrounding sclerosis about the mass. Incidental note is made of a healed NOF of the proximal tibia.
What’s the Diagnosis – Case 126
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What’s the Diagnosis – Case 126
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Diagnosis: Osteosarcoma This case was terrifying to me and a number of my colleagues. In looking at just the second set of radiographs, the radiolucency with sclerosis of the distal femur and the aggressive periosteal reaction would make osteosarcoma a relatively easy diagnosis. However, given the recent, normal radiographs predating the abnormal radiographs, the thought was perhaps this was more likely infection or eosinophilic granuloma. Given the unbelievably rapid progression of this process it is thought that this is going to be a very high grade malignancy but that pathology is not yet available. This case just elucidates the limitations of radiographs at times and the sometimes terrifying nature of practicing medicine.
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