Weekly Case

Title : Case 914

Age / Sex : 73 / F


Chief complaint : Right hip pain

# right side weakness due to stroke
# Brain MRI: old infarctions in the left cerebral hemisphere, left corona radiata



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 : 강유선 (Yusuhn Kang), 분당서울대학교병원 (Seoul National University Bundang Hospital)


Diagnosis:

(Neurogenic) Heterotopic Ossification



Discussion


Neurogenic heterotopic ossification (NHO) is a condition in which ectopic bone forms in soft tissue following an injury to the brain or spinal cord. NHO is common around the hip, knee and shoulder joints, and may cause pain, contractures, and impaired movement. In the early stage, the patients presents with localized pain, swelling and tenderness and may clinically and radiologically mimic infection.

Findings
- enlargement of muscle with heterogeneous high T2 signal
surrounding soft tissue edema
- heterogenous enhancement of the affected muscle

References
1. Sullivan MP, Torres SJ, Mehta S, Ahn J. Heterotopic ossification after central nervous system trauma: A current review. Bone Joint Res. 2013;2(3):51-57. Published 2013 Mar 1. doi:10.1302/2046-3758.23.2000152
2. Wong KR, Mychasiuk R, O'Brien TJ, Shultz SR, McDonald SJ, Brady RD. Neurological heterotopic ossification: novel mechanisms, prognostic biomarkers and prophylactic therapies. Bone Res. 2020;8(1):42. Published 2020 Dec 9. doi:10.1038/s41413-020-00119-9



Correct Answer
Total applicants 25 Correct answers 12
Name Institution
고일권 전문의
이규정 고려대학교 안암병원, 전문의
조서범 전공의
윤정택 전공의
곽경수 전문의
여준범 전문의
도윤아 전문의
윤유성 경북대학교병원, 전문의
임현재 전문의
조항준 전공의
전예진 전문의
김지환 전문의
Semi-Correct Answer
Total applicants 25 Semi-Correct answers 1
권기언 전문의


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