What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The image for this month’s challenge was submitted by Timothy Bert, MD, a resident member at the University of Tennessee–Campbell Clinic. The radiograph is of a 70-year-old female with right hip pain. What’s your diagnosis?

A. Eosinophilic granuloma
B. Fibrous dysplasia
C. Chondrosarcoma
D. Paget’s disease

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Radiograph (top) and magnetic resonance image (bottom) of a 70-year-old female with right hip pain.

Did you get it right?
Last month, Tyler Austin Cannon, MD, provided an anteroposterior radiograph of an 11-year-old girl who had been in a motor vehicle accident and initially diagnosed with a “right clavicular fracture” at an outlying facility. According to Dr. Cannon, the correct diagnosis is congenital pseudarthrosis of the clavicle. He explains that both the radiographic appearance (clear separation of the fragments, bone ends that appear smooth and rounded, and no evidence of callus formation between the segments) and the location—right midclavicle—are suggestive of clavicular pseudarthrosis. “The lack of symptoms and the risk of complications from surgery make treatment controversial,” notes Dr. Cannon, “with some recommending early surgical treatment of even asymptomatic pseudarthroses to avoid later functional and cosmetic deformities and others advising surgery only for pain or a severe cosmetic deformity. Because it is uncommon, and because many patients have surgical treatment at an early age, the true natural history of congenital pseudarthrosis of the clavicle is unknown. This child was treated conservatively because of her lack of symptoms and the presence of only a slight cosmetic deformity; it is possible that, as she ages, symptoms will increase or the cosmetic deformity will progress until surgery is indicated.”

Do you have a challenging case you’d like to submit for publication? E-mail a short case description and any accompanying images to aaoscomm@aaos.org

The answer to this challenge is B. Fibrous dysplasia

AAOS Now
May 2011 Issue
http://www.aaos.org/news/aaosnow/may11/clinical6.asp