Caceres’ Corner: Case No.17 (Update: Solution)

Dear friends,

Muppet was grumpy and decided to spent the Easter vacation in the Costa Brava (I suspect he had a secret date with Miss Piggy). He sent the above picture and the following case:

Seventy-five year-old woman, with pain in the back

Diagnosis:

1. Metastases
2. Lymphoma
3. Paget’s disease
4. None of the above

Seventy-five year-old woman, PA chest

Seventy-five year-old woman, PA chest

Seventy-five year-old woman, lateral chest

Seventy-five year-old woman, lateral chest

Click here for the answer to case #17

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    Apr 2012
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    DISCUSSION 22 Comments

    22 Responses to : Caceres’ Corner: Case No.17 (Update: Solution)

    1. Genchi Bari Italia says:

      paget diseases

    2. Marius says:

      Ivory vertebra at T7. To sum up http://radiology.rsna.org/content/235/2/614.full.pdf : Met, Paget, Lymphoma > anything else. For Paget- there is no expansion / there would rather be the picture frame. I don’t see any evidence of hillar or right paratracheal ADP.
      Osteoblastic lesion occupying the postero-inferior part of L2 body.
      There also seems to be a expansile mixed lesion at the inferior angle of the left scapula.
      So i’m leaning towards metastases. Hope it’s not some weird carcinoid 🙂 I’m waiting for answer. That’s all i got right now.
      Trachea is pushed to the right by a dilated aorta.

    3. Genchi Bari Italia says:

      lA SCLEROSI OSSEA è OMOGENEA E NON SI ACCOMPAGNA A DEFORMAZIONE E-O COLLASSO SOMATICO: PERTANTO è DA RIFERIRE AI PAGET. nON PUà PERTANTO ESSERE Nè UN LINFOMA NE UNA METASTASI. nON MI RISULTRA CHE CI SIANO ALTRE CAUSE DI VERTEBRA ” D’AVORIO”. è STATA DOSATO LA IDROSSIPOLINA URINARIA??

    4. Jose Caceres says:

      urinary hydroxyproline was not evaluated

    5. Albert says:

      Also saw the permeative pattern on the left scapular inferior angle and I’ll go for mets.

    6. saly says:

      i think it is metastasis, the findings of pagets disease is not seen as well as enlarged hilar LNs that suggests lymphoma>

    7. Anna says:

      Cadaques 😉 the top picture. As far as the other two are concerned I would vote for four. Greetings to Mr. Muppet. Hope he visited Mr. Dali’s house 😉

    8. Manuela says:

      This is an Ivory vertebra. The three main differential diagnosis for an Ivory vertebra are: blastic metastasis, Paget disease and Hodgkin’s lymphoma. The normal concavity of the vertebral body is unaltered and there is no bone expansion or squaring off of the vertebral body. Also, there is no hilar or mediastinic adenopathy. So I think the most probable diagnosis is metastases. There is also an enlarged thoracic aorta.

    9. Esin Gezmis says:

      I’ ll go for “osteoblastic metastases” too. Considering patient’s age, the absence of lymph nodes and “picture frame” sign, it seems like the best choice 🙂

    10. Katerina says:

      Osteoblastic lesions occupying the entire body of TH6 (ivory vertebra), part of the body of L1 and the inferior angle of the left scapula.
      Small osteoblastic lesions are seen in the sternum, in the 3rd right rib and (maybe) in the 1rst left rib.

      I vote for 1. Metastases

    11. Mehran says:

      more likely Lymphoma

    12. Marcela says:

      1. Osteoblastic Metastases, unless this patient had a previous osteolitic Mets treated with QMT/RDT and now it seems like osteoblastic.
      In the other hand there is also a nodular image projected in the left upper lobe, that I am not able to identify in the lateral view, and it seems like there is an asimmetry of the left hilium ( more dense and prominent??adenopathy?. No donut sign).

    13. Gyan M says:

      Hi,
      Trachea shifted to right, raised right hemidiaphragm (blunting of anterior cp angle on right side – lateral view)- ??right lowerlobe collapse, a circular transluscent shadow in the lateral view- is it a mediastinal mass?, Rt. apical shadowing and lastly the homogenous radiop opacity of the lumbar vertebra. Am trying to correlate the findings…malignancy?cyst?mediastinal adenopathy? Subpulmonic effusion…Arrow in the dark…

    14. more says:

      http://virilityexreviews.jimdo.com/ Thanks for that awesome posting. It saved MUCH time 🙂

    15. Akash says:

      Sir could you give some light on the dilated aorta ? The trachea is pushed to right. Waiting eagerly for your comment.

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