hospital for special surgery: what’s the diagnosis - case 53
DESCRIPTION
What’s the Diagnosis? is a means for you to test your orthopaedic, rheumatologic and radiology/imaging knowledge. Monthly, new cases will be presented as unknowns. The answers will be available and indexed so that should you want to search on cases representative of a specific topic, you can do so. The cases are from the records of HSS and the teaching files of the Department of Radiology and Imaging. The cases are intended to be representative and informative demonstrating the comprehensive care of Orthopaedics, Rheumatology, Radiology and Imaging and related services at HSS. We know you like to be challenged and hope this section meets your expectations.TRANSCRIPT
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Diagnosis: Transverse Process Stress Fracture
Cases have been presented previously of stress fracture but this case highlights an unusual fracture found infrequently with frequent flexion/extension and rotation activities. It also shows the often subtle nature of findings on radiographs and their difficult interpretation. In this case, the periosteal bone relates to early fracture healing and the central, oval lucency likely represents bone resorption at the site of the fracture. Although the oval lucency may on the surface appear to represent an osteoid osteoma, it does not have the classic well demarcated circular appearance nor any ossified central portion to suggest a nidus. In addition, the history is much more suggestive of an overuse injury than osteoid osteoma.
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This case highlights an important differential diagnosis particulalry in the pediatric population where there is focal peiosteal bone/cortical thickening. As in this case a stress fracture and osteoid osteoma should be considered. In addition, infection, particularly a more chronic infection and eosinophilic granuloma should be considered. The architecture of the findings but also the history are important in reaching the correct diagnosis. As shown in this case, the complimentary nature of multiple studies can also not be stressed enough in reaching the correct diagnosis.
Diagnosis: Transverse Process Stress Fracture