[image: 1.jpg]
This is from today, large erosion of the right femoral hip with joint space
narrowing and marked synovial thickening with capsular distention.
Mild left hip synovitis.
Extensive Rt > Lt iliac and lumbar lymphadenopathy
[image: 2.jpg]
[image: 3.jpg]
[image: 4.jpg]
[image: 5.jpg]
[image: 6.jpg]
I was considering some crazy case of lymphoma with synovial infiltration
and osseous erosion / bone destruction….
But I just realized the pelvis / hip XRs are 3 years old….of course they
were reported as “Unremarkable” (some people have a high threshold, I
guess).
I really think there is erosion of the lateral Rt femoral head in 2018.
So, now what?
Is this all some chronic inflammatory arthropathy?
Why such massive lymphadenopathy?
Obviously needs a biopsy…..but I’m looking for advice before I report
this.
Thanks.
Hilary
I’m receiving many comments….thank you—-keep them coming….
I failed to mention the severe, global muscle atrophy, which I presume to
be related to the reported history of MS.
She is a clinic patient…I tried to call the doctor…but that was a while
ago and I was afraid I would still be on hold.
I will request that the doctor call me….hey, I can dream….
On Tue, Aug 24, 2021 at 12:46 PM hilary umans <hilary.umans@gmail.com>
wrote:
[gallery]
Thanks to everyone who responded.
The consensus is TB…I agree it’s most likely.
As Dr. Rubin suggested, something as simple as CXR and ppd might be
diagnostic.
My guess is she’s probably had BCG, but that’s just a guess.
There’s plenty to biopsy.
The only other imaging studies we have are recent C and L spine MRI (cord
look normal) and Brain MRI from 2008 that was reported normal.
No CXR.
I have her last clinic note….described severe (9/10) pain and documented
her sad mood. You think???!!!!
I really wonder about the legions of people….mostly women, accused of
having fibromyalgia—-to
excuse the shortcomings of the treating physicians.
But now I’m editorializing……
On Tue, Aug 24, 2021 at 12:46 PM hilary umans <hilary.umans@gmail.com>
wrote:
[gallery]