Here is another case that I am hoping Dr. Gorbachova will comment on. 14 y/o M with "months history" of swelling, instability and buckling. No history of specific antecedent trauma.
Looks in the spectrum of osteochondritis dissecans vs osteochondrosis to me. What do you think? Simultaneous patella and medial tibial plateau? One of each? Neither?
Another great article btw: https://pubs.rsna.org/doi/pdf/10.1148/rg.2018180044
-- Phillip Tirman MD
Renaissance Imaging Center Westlake Village
Renaissance Imaging Center Westlake Village
Two Dole Drive
Westlake Village, CA 91362
Tel: 818-575-8066
Happy to comment , as an OCD enthusiast rather than an expert...I am instantly humbled by cases like this one.
ReplyDeleteWe see irregular deformed subchondral bone plate, in locations atypical for OCD (D- for dissecans) . Hmm, if these were OCDs, the progeny fragment must have been unstable and long gone, leaving a crater- and it somehow doesn't quite look like that, looks like an indentation rather than a missing piece.
My differential is that either we are looking at postraumatic lesions- like one from transient lateral patellar dislocation ,+ subacute osteochondral fracture in the medial plateau, or ( if history of no trauma is true) some kind of epiphyseal dysplasia , like spondylo-epiphyseal dysplasia tarda, and we should look at the spine and other joints -hips and knees, and keep googling or ask our pediatric colleagues...
Would be very interested to hear what others think.
Tetyana