3 thoughts on “Time Sensitive, Please Help. 17F 2 months posterior knee pain, no trauma”
ocad-msk
sure looks like MO to me
time frame between PFs and MR is 1 month, yes?
would love to just see a repeat PF today … or failing that a CT … look for characteristic MO forming
might just solve the whole mystery right there
pete
Peter C. Young, MD
Section Head, Division of Musculoskeletal Radiology
University Hospitals Cleveland Medical Center
Case Western Reserve University
11100 Euclid Avenue Cleveland, OH 44102
(216) 844-1542
________________________________
Sent: Friday, February 25, 2022 11:59 AM
US done by orthopedist in office (no images captured) reported “anechoic area”. Was referred a few weeks later for guided aspiration, but US appearance (no images) looked complex, so there was no aspiration—sent for this MRI instead.
[17F leg consult.jpg]
US done by orthopedist in office (no images captured) reported “anechoic area”. Was referred a few weeks later for guided aspiration, but US appearance (no images) looked complex, so there was no aspiration—sent for this MRI instead.
[17F leg consult (1).jpg]
These are open 1.2T MR images, FYI
[17F leg consult (2).jpg]
[17F leg consult (3).jpg]
[17F leg consult (4).jpg]
[17F leg consult (5).jpg]
This is from my colleague, Nidhi Jain.
She wrote: This is a 17 year old patient who presented to peds ortho a month ago for pain that started in early January (almost 2 months ago now). No recalled inciting event — no recalled trauma, no local skin infection. An US done in peds ortho office one month ago supposedly showed an “anechoic collection” in the area, but we have no images from it to confirm that. The patient was referred to a PMR for drainage under US guidance a few weeks later, but the PMR MD rightfully recognized this was a complex lesion and sent the patient for MR. X rays from one month ago show no local mineralizations.
We’re trying to figure out how to guide workup on this case. The pattern of edema throughout multiple muscles is confusing. Could this be the beginning stages of MO if perhaps the patient had unrecalled trauma? Infection? Or could there be any neoplasm that generates this appearance?
[gallery]
graemevthompson
The one thing I’d make sure it’s not is a false aneurysm that has bled.
Graeme
Sent from my iPhone
ptirmanmd
Great suggestion. See Jana Crain’s sports medicine case from a few months back (in the video archive).
time frame between PFs and MR is 1 month, yes?
would love to just see a repeat PF today … or failing that a CT … look for characteristic MO forming
might just solve the whole mystery right there
pete
Peter C. Young, MD
Section Head, Division of Musculoskeletal Radiology
University Hospitals Cleveland Medical Center
Case Western Reserve University
11100 Euclid Avenue Cleveland, OH 44102
(216) 844-1542
________________________________
Sent: Friday, February 25, 2022 11:59 AM
US done by orthopedist in office (no images captured) reported “anechoic area”. Was referred a few weeks later for guided aspiration, but US appearance (no images) looked complex, so there was no aspiration—sent for this MRI instead.
[17F leg consult.jpg]
US done by orthopedist in office (no images captured) reported “anechoic area”. Was referred a few weeks later for guided aspiration, but US appearance (no images) looked complex, so there was no aspiration—sent for this MRI instead.
[17F leg consult (1).jpg]
These are open 1.2T MR images, FYI
[17F leg consult (2).jpg]
[17F leg consult (3).jpg]
[17F leg consult (4).jpg]
[17F leg consult (5).jpg]
This is from my colleague, Nidhi Jain.
She wrote: This is a 17 year old patient who presented to peds ortho a month ago for pain that started in early January (almost 2 months ago now). No recalled inciting event — no recalled trauma, no local skin infection. An US done in peds ortho office one month ago supposedly showed an “anechoic collection” in the area, but we have no images from it to confirm that. The patient was referred to a PMR for drainage under US guidance a few weeks later, but the PMR MD rightfully recognized this was a complex lesion and sent the patient for MR. X rays from one month ago show no local mineralizations.
We’re trying to figure out how to guide workup on this case. The pattern of edema throughout multiple muscles is confusing. Could this be the beginning stages of MO if perhaps the patient had unrecalled trauma? Infection? Or could there be any neoplasm that generates this appearance?
[gallery]
Graeme
Sent from my iPhone