Assuntos
Debilidade Muscular/diagnóstico por imagem , Neuropatia Radial/diagnóstico por imagem , Progressão da Doença , Feminino , Antebraço/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Debilidade Muscular/etiologia , Neuropatia Radial/complicações , Ultrassonografia , Adulto JovemRESUMO
BACKGROUND: The suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures. METHODS: Patients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks. RESULTS: 68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified. CONCLUSIONS: CBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.
Assuntos
Fraturas Ósseas , Osso Escafoide , Traumatismos do Punho , Tomografia Computadorizada de Feixe Cônico/métodos , Estudos de Viabilidade , Fraturas Ósseas/diagnóstico por imagem , Humanos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Traumatismos do Punho/diagnóstico por imagemRESUMO
A 66-year-old woman presents with progressive bilateral swelling of her fingers, elbows, and toes. Initially thought to represent an inflammatory peripheral arthropathy, the patient underwent rheumatology review, but subsequent tissue biopsy confirmed diffuse large B-cell lymphoma. Results of bone marrow biopsy and staging CT were negative. F-FDG PET/CT demonstrates FDG-avid bony and adjacent soft tissue disease limited to the extremities with an excellent metabolic response to primary chemotherapy. This is a rare case of primary bone lymphoma limited to the extremities mimicking an inflammatory peripheral arthropathy.