NEJM Image Quiz

Try this link out as a "instant unknown".http://image-challenge.nejm.org/?ssource=rthome#12252008

Bone Sarcoid

Bone involvement by sarcoid most commonly involves the extremities. Dr. Suwan gave me this interesting case.

A 32 yr old African American female with history of breast cancer and pulmonary sarcoidosis. Staging work-up included a bone scan.

Bone scan images showing multiple foci of increased radioactivity in the skull.
Given the history of breast cancer, the lesions were called metastasis.

CT Shows osteolytic lesions in the skull, thought to be metastasis.


Contrast enhanced MR images demonstrating multiple enhancing skull lesions.


These skull lesions were stable on 6 months follow up CT and bone scan. A direct biopsy was performed revealing non-caseating granulomas consistent with sarcoidosis. No evidence of metastasis.

Thank you, Dr. Suwan

Here is a concise link from the Univ of Washington about bone sarcoid you may find helpful. http://uwmsk.org/residentprojects/sarcoid.html

Images of Conditions That May Be Associated with "Noisy Hips" Part 3

Trochanteric Bursitis
Left Hip

MyPacs.net Case 1758632

Images of Conditions That May Be Associated with "Noisy Hips" Part 2

Loose Body

Radiographics 2oo2 22,1223-1246

Images of Conditions That May Be Associated with "Noisy Hips"

Iliopsoas Bursitis

Axial

Sagittal

The Clicking or Snapping Hip - "Coxa Saltans"

I had heard of "coxa vara", "coxa valga", and "coxa magna" - but when I received a request with the history of "coxa saltans" I was stumped. So what is "coxa saltans".

Check this link http://www.sportsinjurybulletin.com/archive/clicking-hip.html

Here is a video link demonstrating an "external snapping hip" http://www.youtube.com/watch?v=S9ZEHlLilTM

I am familiar with the "snapping hip". "Coxa saltans" is a term that I had not encountered before. I have performed sonography on snapping IT bands (external snapping) and ilioposas tendons (internal snapping), but am unable upload the clips. Ask me to pull them up sometime at the office.