|
Year |
2002 |
|---|---|
|
Question Number |
94 |
|
Category |
Orthopaedic Disease |
Question
A 12-year-old girl has had localized back pain for the past 6 months. There is no associated febrile illness or constitutional symptoms. The MRI scans and radiographs shown in Figures 15a through 15c reveal coarse striations. Laboratory studies show that the CBC and erythrocyte sedimentation rate are within normal limits. What is the most likely diagnosis?
1- Nonossifying fibroma
2- Unicameral bone cyst
3- Osteoblastoma
4- Hemagioma of bone
5- Fibrous dysplasia
Figures
Answer (click for answer)
Answer-4- Hemangioma of bone
Hemangiomas are frequently found as an asymptomatic finding on MRI or can present as pain or pathologic fracture. The classic finding of bright signal on T2 weighted images and intermediate on T1 are consistent with its vascular nature. It relative uniformity on MRI except for striation(better seen on plain films) is pathonomonic. Although benign, pathologic fracture can occur. Of the other choices given osteoblastoma is the only common spine tumor and it usally occurs in the posterior elements. Its MRI appearance would be of similar findings as bone not water and you would expect to find an elevated ESR. The real key to this one is the jailhouse striations of hemangiomas.
Reference: Miller MD: Review of Orthopaedics ed 3. Philadelphia PA,WB Saunders, 2000, p 372.