Weekly Case

Title : Case 679

Age / Sex : 64 / M


Chief complaint: Left shoulder pain (6MA)


  Incidentally detected bony abnormality on FU MRI



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 : 
최자영 (Ja-Young Choi),  서울대병원(Seoul National University Hospital)


Diagnosis:

Focal bone abnormality as a complication of ultrasound diathermy



Discussion


Findings:



  • Interval development of focal bone abnormality 6 months later

  • Subchondral arc lesions with low signal intensity in the superolateral humeral head on T1W and high signal intensity on T2W.

  • At the side of the bone facing the body surface

  • Without involvement of the deeper aspects of the bone marrow

  • Disappearance on 3-month FU MRI (not shown)


   


Differential Diagnosis: Osteonecrosis


 


Discussion:



  • Caused by thermal damage to the bone tissue

  • MR features:

  • Imaging appearance similar to focal osteonecrosis

  • Subchondral rim or arc lesions with low signal intensity on T1W and high signal intensity on T2W.

  • Usually smaller and superficially located (different from osteonecrosis)

  • Unique location

  • Superficial location without involvement of the deeper aspect of the bone marrow.

  • On the sides with thinner overlying soft tissue

  • On the side of the bone facing the body surface

  • Clinical significance

  • Usually mild and transient, with apparent full recovery after termination of therapy

  • Ultimately heal itself (mostly reversible)


 


References:


 



  1. Yeh LR, Chen CK, Tsai MY, Teng HC, Lin KL. Focal Bone Abnormality as a Complication of Ultrasound Diathermy: A Report of Eight Cases Radiology. 2011;260(1):192-8.

  2. Kim SJ, Kang Y, Kim DA, Lim JY, Park JH, Oh JH. Focal Bone Marrow Lesions: A Complication of Ultrasound Diathermy Clinics in Shoulder and Elbow 2019;22(1):40-45.



Correct Answer
Total applicants 31 Correct answers 14
Name Institution
여현정 전문의
김기욱 전문의
김형민 연세의대 강남세브란스병원, 전문의
조신영 전문의
송윤아 전문의
이혜란 전문의
이승보 서울아산병원, 전문의
김유진 전문의
이현규 전문의
김동언 서울아산병원, 전문의
권기언 서울아산병원, 전문의
김성진 365병원, 전문의
심상우 서울아산병원, 전문의
안태란 길병원, 전문의


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