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Age / Sex : 35 / M
Age / Sex : 7 / F
Chief complaint : Left elbow pain (duration: 3 days)
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 : Sang-Min Lee, CHA Bundang Medical Center, CHA University
Diagnosis: Panner’s disease
Discussion
Findings:
1. On AP
radiography, sclerosis and curvilinear radiolucent line within the capitellar
ossification center
2. T1-weighted
and fat-supressed proton density coronal images reveal decreased signal
intensity throughout the capitellum. The overlying articular cartilage is
intact.
3. On
postcontrast fat-supressed T1-weighted coronal and sagittal images, capitellar
ossification center is not enhanced.
Differential Diagnosis: Osteochondritis dissecans
Diagnosis:
Panner’s disease
Discussion:
1.
Osteochondrosis of the capitellum, known as Panner’s disease
2. Panner’s
disease occurs in childhood as opposed to osteochondritis dissecans, which
typically occurs in adolescence.
1) Panner’s disease : 5- to 11-year-olds,
before ossification of the capitellum is complete
2) Osteochondritis dissecans: 13- to 16-year-olds
3. Boys are
affected almost exclusively, and the condition is commonly linked to a history
of trauma (“Little Leaguer’s elbow”)
4.
Radiographic findings
1) Sequential sclerosis, fissuring,
fragmentation, collapse, and reossification
2) Hyperemia may result in an enlarged
radial head and premature epiphyseal fusion.
5. MR
findings
1) T1-weighted images: fragmentation
and abnormally decreased signal intensity within the ossifying capitellar
epiphysis
6. The
condition is similar to Legg-Calve-Perthes disease of the hip in that patients
may recover with little or no deformity. Even without treatment, the articular
surface typically remains intact and does not undergo fragmention or loose body
formation.
References:
1. David W.
Stoller. Magnetic resonance imaging in orthopaedics and sports medicine, 3rd
ed., Lippincott Williams and Wilkins, Philadelphia, 2007;1582-1585.
2. Resnick,
Kransdorf. Bone and joint imaging, 3rd ed., Elsevier Saunders, Philadelphia, 2005;1098.
3. Terry R.
Yochum, Lindsay J. Rowe. Essentials of skeletal radiography, 3rd
ed., Lippincott Williams and Wilkins, Philadelphia,
2005;1486.
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