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Age / Sex : 66 / F
Age / Sex : 66/F
Chief complaint :
Painless masses at
sacral and bilateral gluteal regions
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of
this case.
* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)
Courtesy : Kyu-Sung Kwack, Ajou University Medical Center, Ajou University
School of Medicine
Diagnosis: Multiple Bursal Cysts (Bursitis) in Systemic Sclerosis
Discussion
Findings:
Muliple
variable sized cystic masses were noted at sacral region and bilateral gluteal
regions on enhanced computed tomography. The cystic masses showed lobuated
contours and thin cystic walls.
Differential Diagnosis:
No
Diagnosis:
조직검사는 시행안하였습니다.
Discussion:
9 years
after the onset of diffuse systemic sclerosis (SSc), she had noticed a gradual
enlargement of a painless swellings gradually developed in various regions such
as a sacral region and bilateral gluteal regions. These elastic masses were 3
cm to 10 cm in diameter. We may encountered a patient with multiple swellings
caused by bursitis accompanied with SSc (systemic sclerosis). Although it is
plausible to speculate that subcutaneous bursitis easily occurs in SSc because SSc
involves microvascular circulation, loose connective tissue, and bony
constitution. Bursitis in SSc can be classified into four types: bursal
calcinosis, dry (or fibrous) bursitis; effusive bursitis; and septic bursitis. Bursitis
generally belong to either bursal calcinosis or septic bursitis occuring at
olecranon and prepatellar region. Bursal calcinosis type is sometimes
accompanied with tuberculosis and staphylococcal infection, consisting of a
large number of rice-sized calcifications in the fluid.
References:
1. Tanemura
et al. Multiple Bursal Cysts in Systemic Sclerosis. Dermatol Surg
2002;28:1177–1179.
2. Bywaters
EGL. The bursae of the body. Ann Rheum Dis 1965;24:215–8.
3. Lagana A,
Canoso JJ. Subcutaneous bursitis in scleroderma. J Rheumatol 1992;19:1586–90.
4. Ishikawa
O, Akimoto S, Sato M, Miyachi Y. Multiple bursitis in systemic sclerosis. J
Rheumatol 1997;24:1189–90.
5. Weinstein
PS, Canoso JJ, Wohlgethan JR. Long-term follow-up of corticosteroid injection
for traumatic olecranon bursitis. Ann Rheum Dis 1984;43:44–6.
6. Fam AG,
Pritzker KPH, Stein JL, Houpt JB, Little AH. Apatiteassociated arthropathy. A
clinical study of 14 cases and of 2 patients with calcific bursitis. J
Rheumatol 1979;6:461–71.
7. Ho G Jr,
Tice AD. Comparison of nonseptic and septic bursitis. Arch Intern Med
1979;139:1269–73.
8. Ihara K,
Toyoda K, Ofuji A, Kawai S. Tuberculous bursitis of the greater trochanter. J
Orthop Sci 1998;3:120–4.
9. Fam AG,
Pritzker KPH. Acute calcific periarthritis in scleroderma. J Rheumatol
1992;19:1580–5.
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