EURORAD ESR

Case 11319

Polyostotic fibrous dysplasia: Atypical presentations with spinal involvement

Author(s)
Shantiranjan Sanyal, Deb. K. Boruah, Aparimita Gogoi, Lalendra Upreti

Assam Medical College, Dibrugarh,
Assam, India;
Email:srsanyal@gmail.com
 
Patient
male, 45 year(s)
 
 
  • Figure 1
    X-ray DL spine

    X-ray shows multiple expansile lytic lesions with intact sclerotic cortices involving multiple bilateral upper ribs and left scapula.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 2
    Axial CT

    Lesions with ground glass matrix involving lower cervical and dorsal vertebrae, their posterior elements, costovertebral junctions.

     
    Area of Interest: Spine; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 3
    Axial CT dorsal spine

    Expansile lesions with ground glass matrix involving multiple bilateral ribs, left scapula, dorsal vertebrae.

     
    Area of Interest: Spine; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 4
    Axial CT lumbosacral
     

    Similar lytic lesions with sclerotic margin involving body and posterior appendages of lumbar vertebrae.

     
    Area of Interest: Spine; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Expansile lytic lesions with sclerotic cortices seen in sacrum as well.

     
    Area of Interest: Spine; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 5
    MR coronal
     

    T2W coronal: multiple expansile solid-cystic lesions involving lower cervicodorsal vertebrae, bilateral upper ribs, left scapula. The solid components are heterogeneously hyperintense in T2 , with few cystic...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    T1W Post contrast coronal: heterogeneous solid-cystic areas of enhancement involving dorsal spine bilateral upper ribs, left scapula.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 6
    MR sagittal
     

    Sag STIR: epidural extension posteriorly causing secondary canal stenosis at D2/ D3 levels causing compressive cord myelopathy. Collapse of D3 noted.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Sag T1W:Prevertebral and epidural extension of the lesion posteriorly causing secondary spinal canal stenosis at D2 & D3 levels.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Sag T1 post contrast: Prevertebral and epidural extension posteriorly causing secondary spinal canal stenosis at D2 & D3 levels with collapse of D3.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
  • Figure 7
    Axial MR
     

    Axial T1W showing lobulated expansile lesions uniformly hypointense involving bilateral ribs, dorsal vertebrae with epidural extension posteriorly.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;

    Axial T1W post contrast study: heterogeneous solid cystic areas of enhancement seen on post contrast study with lesions encroaching spinal canal causing canal stenosis.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias;
     
     
X-ray shows multiple expansile lytic lesions with intact sclerotic cortices involving multiple bilateral upper ribs and left scapula.
 
Lesions with ground glass matrix involving lower cervical and dorsal vertebrae, their posterior elements, costovertebral junctions.
 
Expansile lesions with ground glass matrix involving multiple bilateral ribs, left scapula, dorsal vertebrae.
 
Similar lytic lesions with sclerotic margin involving body and posterior appendages of lumbar vertebrae.
 
Expansile lytic lesions with sclerotic cortices seen in sacrum as well.
 
T2W coronal: multiple expansile solid-cystic lesions involving lower cervicodorsal vertebrae, bilateral upper ribs, left scapula. The solid components are heterogeneously hyperintense in T2 , with few cystic components showing fluid signal.
 
T1W Post contrast coronal: heterogeneous solid-cystic areas of enhancement involving dorsal spine bilateral upper ribs, left scapula.
 
Sag STIR: epidural extension posteriorly causing secondary canal stenosis at D2/ D3 levels causing compressive cord myelopathy. Collapse of D3 noted.
 
Sag T1W:Prevertebral and epidural extension of the lesion posteriorly causing secondary spinal canal stenosis at D2 & D3 levels.
 
Sag T1 post contrast: Prevertebral and epidural extension posteriorly causing secondary spinal canal stenosis at D2 & D3 levels with collapse of D3.
 
Axial T1W showing lobulated expansile lesions uniformly hypointense involving bilateral ribs, dorsal vertebrae with epidural extension posteriorly.
 
Axial T1W post contrast study: heterogeneous solid cystic areas of enhancement seen on post contrast study with lesions encroaching spinal canal causing canal stenosis.
 
 
 
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