Weekly Case

Title : Case 748

Age / Sex : 89 / M


Chief complaint : Right lower leg pain


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 김완태 (Wan Tae Kim), 중앙보훈병원 (Veterans Health Service Medical Center)


Diagnosis : 


Primary lymphoma of bone (Diffuse large B-cell lymphoma)


Findings

- Plain radiograph


  : Tibia AP view shows well defined osteolytic lesion and focal permeative change in distal diaphysis of right tibia.


- MR findings



  • T1-weighted image shows intermediate signal intensity intramedullary lesion with minimal cortical erosion of right tibia.

  • T2-weighted image shows heterogenous high signal intensity intraosseous mass lesion and soft tissue infiltration.

  • Contrast enhanced T1-weighted image demonstrates heterogenous enhancement of intraosseous and soft tissue mass.


Differential diagnosis


  1. Metastasis

  2. Osteomyelitis

  3. Osteosarcoma



References

1.Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999 Dec;173(6):1691-1697.


2.Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. 2003 Nov-Dec;23(6):1371-1383.


3.Heyning FH, Kroon HM, Hogendoorn PC, Taminiau AH, van der Woude HJ. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol. 2007 Oct;36(10):937-944.








Correct Answer
Total applicants 24 Correct answers 7
Name Institution
이규정 국군대전병원, 전문의
김종혁 서울아산병원, 전문의
박영태 서울아산병원, 전문의
이혜란 전문의
김경호 서울아산병원, 전문의
김성진 365병원, 전문의
김용희 예손병원, 전문의
Semi-Correct Answer
Total applicants 24 Semi-Correct answers 2
김기욱 전문의
임윤진 단국대학교병원, 전공의


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