14 y/o s/p Martial Arts injury. Noticed a growth on X-ray

Ticks and fleas. The osteochondroma is pretty easy to see. Also ligamentum mucosum/infrapatellar plica edema (sprain vs frictional inflammation) and something in the prefemoral fat.

How would you describe the hoffa's and pre femoral findings? 

What do you recommend as far as the osteochondroma for follow up (if anything?)

Phillip Tirman MD  

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What is this Upper Arm Mass?

Case workup and presentation by our Fellow at MD Anderson Cancer Center, Marwa Zaid.

50-year-old woman with right arm pain and swelling. Past medical history significant for right breast cancer.









What's your differential?


We considered angiosarcoma (given breast cancer and chronic lymphedema), massive localized lymphedema (given history and mass-like appearance, though not the typical appearance), and liposarcma (given fatty component).

The answer surprised us.

This is an omental flap for treatment of chronic refractory lymphedema.

The omomentum is a highly vascularized intra-abdominal structure that is basically a flattened lymph node and provides excellent protection against inflammation and irradiation.

The omentum can be exteriorized and lengthened into a vascular pedicle.

Preoperative lymphoscintigraphy with SPECT/CT scan of the affected regional lymph nodes is typically done prior to surgery. Otherwise, imaging has no role.

You can see a video of omental flap harvest here

https://journals.lww.com/plasreconsurg/Pages/videogallery.aspx?videoId=658&autoPlay=true

References:

Nguyen AT, et al. Laparoscopic Free Omental Lymphatic Flap for the Treatment of Lymphedema. Plastic and Reconstructive Surgery: July 2015 - Volume 136 - Issue 1 - p 114–118

10 y/o with palpable lump on his finger. No pain.  3rd and 4th ray are affected.

62 M 6 weeks non-traumatic pain with acute onset

Biopsy proven Epithelioid Hemangioma

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314752/

42 y/o patient referred for back pain.
Incidental L2 lesion.
CT and standard sequences top row, axial T1 VIBE fs C+ below with mild enhacement.

CT shows hazy sclerosis, no lytic areas.

CT + MR

Diagnosis: BNCT

48M 8 months post op FHL transfer for Achilles Rupture

Sag PDFS

Sag T1 arrows shows old healed osteotomy

Cor T2FS

Ax PDFS

The referrer requested assessement of Achilles (specified "posterior tendon") healing, now 8 months after FHL transfer for Achilles rupture.

In the T1-weighted image you can see a healed calcaneal osteotomy, and there is suture artifact around the distal achilles, related to a more remote Haglund's procedure which pre-dated the complete tendon rupture in the hypovascular zone.

Now 8 months out, there is some intrasubstance bright T2 signal at the anterior insertion of the FHL onto the posterosuperior calcaneus, surrounding a bioabsorbable screw, possibly reaction to the screw degradation.

I am both surprised that the referrer wants to evaluate healing of the native achilles, and that there is persistent bright T2 signal in a >3cm achilles defect so long after the initial injury.

Isn't the FHL now replacing rather than augmenting the achilles in this instance?

Why is it important to assess healing of the achilles defect?

20-year-old woman with hip pain

AP view of the right hip

Frog-leg lateral view of the right hip

Zoomed-in view of the frog-leg lateral view

Coronal T1-WI

Coronal T2-WI with FS

Axial T1-WI with FS and contrast

Diagnosis: Plexiform neurofibroma with intra- and extra-articular components

H&E stain showing neurofibromas (*)