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... (AP) ( Fig 1A) and lateral (Fig 1B) plain radiographs showed a complex, ossified mass projecting to the left of the T8 and T9 vertebral levels superimposed over the posterior vertebral bodies and posterior elements in the lateral projection. Additional lesions were noted, involving the costovertebral junction of the 12th rib and left of the T4-5 level projecting over the aortic knob on the AP film. A technetium-99 methylenediphosphonate (99m Tc- MDP) bone scan showed corresponding areas of radio- tracer uptake to the left of the T8-9 and, to a lesser degree, the T4-5 levels. No other areas of uptake were detected in the skeleton (Fig 2). Axial CT scans showed a largely ossified mass, 9 cm in diameter, adjacent to the costovertebral junction at the T9 level with a rind of peripheral soft tissue density and par- tial erosion of the left T9 transverse process (Fig 3). Com- puted tomography scans of the chest (lungs and mediasti- num) and abdomen were normal. On T1-weighted coronal MRI scans, the lesion arising in the ninth left rib showed heterogeneous signal intensity and had low signal intensity in the periphery and intermediate signal intensity centrally (Fig 4A). After intravenous administration of a contrast medium, T1-weighted coronal MRI scans showed areas of mild linear enhancement in the lesion because of very mild uptake of the drug (Fig 4B). On T2-weighted images, the lesion at the T8-9 level showed somewhat lobular margins with peripheral signal hyperintensity and a central area of heterogeneous, but predominantly isointense-to-low, signal intensity. In com- parison, the lesion more superiorly at the T4-5 level showed a more homogeneous mildly hyperintense signal (Fig 4C). There seemed to be an extension of the lesion to the body and neck of the eighth and ninth thoracic verte- brae. Osteochondroma Secondary chondrosarcoma Chondroblastic osteosarcoma Metastatic tumor Lymphoma A biopsy of the lesion arising in the ninth left rib was done and photomicrographs taken (Fig 5). Based on the history, physical findings, laboratory tests, radiographic studies, and histologic picture, what is the diagnosis and how should this lesion be ...
Context 2
... 54-year-old man was referred to the orthopaedic depart- ment for evaluation of pain in the left side of his chest. He complained of constant pain that radiated to the left hypochondrium and to the thoracic spine. Symptoms started insidiously 6 months earlier and became progressively worse. Symptoms subsided with the use of oral analgesics. There was no history of coughing, dyspnea, malaise, fa- tigue, fever, night sweating, or weight loss. There were no other clinical symptoms. Thirty years earlier he was diagnosed with multiple hereditary exostoses that affected primarily the hips, the knees, and the elbows. His father and grandfather were similarly affected. At the time of diagnosis he had surgical resection of exostoses arising in his knees to improve knee function. Fifteen years earlier, he had surgical resection of an exostosis in his right hip for similar reasons. In both cases, biopsies of the removed exostoses were negative for malignancy. The rest of his medical and surgical records were unremarkable. Physical examination revealed an apparently healthy man. There was no tenderness during percussion and palpation of the left chest and left hypochondrium. Percussion and palpation of the spine and paraspinal muscles in the thoracic region revealed no tenderness. Chest auscultation was normal. The range of motion of his spine was in normal limits. His neurologic examination was free of findings. All laboratory values, including erythrocyte sedimenta- tion rate, C-reactive protein, and arterial blood gases were in normal limits. Radiographic investigations included plain radiographs (Fig 1), bone scans (Fig 2), computed tomography (CT) scans (Fig 3) and MRI scans (Fig 4). Based on the history, physical examination, laboratory findings and imaging studies, what is the differential ...
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... investigations included plain radiographs (Fig 1), bone scans (Fig 2), computed tomography (CT) scans (Fig 3) and MRI scans (Fig 4). Based on the history, physical examination, laboratory findings and imaging studies, what is the differential diagnosis? ...
