RESUMO
Postpartum sacral insufficiency fracture is an uncommon occurrence that is often under-diagnosed because its symptoms of low back, buttock and groin pains may initially be attributed to physiologic biomechanical changes caused by pregnancy or to intervertebral disc disease. We present a case of bilateral sacral insufficiency fractures in a 37-year-old postpartum woman with osteopenic bone mineral density confirmed by dual energy X-ray absorptiometry. The symptoms were initially suspected to be of discogenic cause, and the fractures were incidentally appreciated at the edge of a lumbar spine magnetic resonance image. Therefore, it is important to keep in mind this potential diagnosis when examining imaging studies of postpartum patients. For women who present other risk factors of osteoporosis, imaging of the entire sacrum should be part of the imaging studies. If sacral stress fractures are diagnosed, further evaluation for bone mineral density and underlying metabolic bone disease is recommended.
Assuntos
Absorciometria de Fóton/métodos , Fraturas de Estresse/diagnóstico por imagem , Complicações do Trabalho de Parto/diagnóstico por imagem , Transtornos Puerperais/diagnóstico por imagem , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética/métodos , Período Pós-Parto , Gravidez , Sacro/diagnóstico por imagemRESUMO
We present a case of calcific tendinopathy of the rotator cuff with intraosseous migration of the calcification, treated with ultrasound-guided bursal steroid injection and followed up with multiple imaging modalities for a year following the initial presentation. The radiographs, ultrasound, CT, nuclear scintigraphy, and MRI images demonstrate the temporal evolution of the intraosseous migrated calcium and show how this pathology, in its acute phase, can mimic other pathologies like osteoid osteoma. The follow-up imaging also illustrates how the migrated intraosseous focus of calcification took a much longer time to heal compared to its intratendinous counterpart, possibly leading to the protracted course of recovery. This report also highlights a previously undescribed pattern of healing of the intraosseous migrated calcium on multiple imaging modalities.