Radiology Rounds Hand Pain 6 9 08

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Information about Radiology Rounds Hand Pain 6 9 08

Published on June 24, 2008

Author: radrounds

Source: slideshare.net

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41 year old with Hand pain Laura Avery, MD Massachusetts General Hospital Harvard Medical School Boston, MA, USA

 

 

Lacelike appearance to the bone

Lymphadenopathy

 

 

 

 

TREE-IN-BUD

Sarcoid of Bone Distribution: often bilateral Site of origin: cortical with preservation of periosteum Location: most commonly the hands and feet, although the long bones, skull, vertebrae, pelvis, ribs, sternum, and calcaneus can rarely be affected Position: usually at the ends of affected bones Shape: cystic or  lacelike with minimal involvement of adjacent soft tissues or extensive bone erosion with pathologic fracture Calcification: absent

Distribution: often bilateral

Site of origin: cortical with preservation of periosteum

Location: most commonly the hands and feet, although the long bones, skull, vertebrae, pelvis, ribs, sternum, and calcaneus can rarely be affected

Position: usually at the ends of affected bones

Shape: cystic or  lacelike with minimal involvement of adjacent soft tissues or extensive bone erosion with pathologic fracture

Calcification: absent

Sarcoid of Bone Small bone sarcoidosis Lesions affecting the small bones of the hands and feet typically have a lytic or lacy reticular appearance on conventional radiographs. Lytic lesions are either minute cortical defects in the phalangeal heads or larger rounded punched-out lesions involving the cortex and medulla. The middle and distal phalanges are the most frequently involved. The lytic lesions likely represent an osteoporotic process producing local and destructive tunneling. The lacy reticular pattern is seen when the tunneling of the cortex is followed by remodeling of the cortical and trabecular architecture. The concave shape of the phalangeal shafts then becomes more tubular. There is often accompanied soft tissue swelling. More localized lytic lesions are also seen, forming cystic defects that may become surrounded by a thin rim of sclerosis as they heal.

Small bone sarcoidosis

Lesions affecting the small bones of the hands and feet typically have a lytic or lacy reticular appearance on conventional radiographs. Lytic lesions are either minute cortical defects in the phalangeal heads or larger rounded punched-out lesions involving the cortex and medulla.

The middle and distal phalanges are the most frequently involved. The lytic lesions likely represent an osteoporotic process producing local and destructive tunneling.

The lacy reticular pattern is seen when the tunneling of the cortex is followed by remodeling of the cortical and trabecular architecture. The concave shape of the phalangeal shafts then becomes more tubular. There is often accompanied soft tissue swelling. More localized lytic lesions are also seen, forming cystic defects that may become surrounded by a thin rim of sclerosis as they heal.

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