musculoskeletal pseudo-tumor - mahidol university · musculoskeletal pseudo-tumors from radiography...
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Musculoskeletal Pseudo-tumor
Korkiat Vivitmongkolchai, MD.
Faculty of Medicine
Thammasat University
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Enchondroma?
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Osseous lymphoma?
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Metastasis?
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T1W T2FS T1FS+Gd
Soft tissue sarcoma?
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Soft tissue sarcoma?
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Pseudo-tumor
Musculoskeletal pseudo-tumors from physical exam
(palpable mass)
Musculoskeletal pseudo-tumors
from radiography (osteolytic lesion)
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Palpable Pseudo-tumor
Three broad categories
Normal variant
Traumatic lesion
Infection/Inflammation
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Palpable Pseudo-tumor
Normal variant Asymmetric fat deposition Asymmetric muscle/tendon
hypertrophy Accessory muscle Bony prominence
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Palpable Pseudo-tumor
Traumatic lesions
Muscle/tendon tear or rupture
Hematoma
Morel-Lavallee lesion
Myositis ossificans (traumatic heterotopic ossification)
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Palpable Pseudo-tumor Infection or inflammation Focal myositis or myopathy Abscess Tenosynovitis Bursitis Myonecrosis fat necrosis FB granuloma or other granulomatous lesion Arthritis
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Radiographic Pseudo-tumor
Pseudo-lesions
Fat deposition in bone marrow & Localized osteoporosis (Disuse)
Osteomyelitis
Insufficiency fracture
Hemophilic pseudo-tumor
Arthritis/arthropathy
Metabolic disease (e.g. Brown tumor, amyloidosis)
Particle disease
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Radiographic Pseudo-tumor
Osteomyelitis Osteomyelitis with moth-eaten or permeative
bone destruction may mimic malignant bone tumor e.g. metastasis, multiple myeloma, Ewing’s sarcoma, NHL, etc.
Indolent osteomyelitis with geographic bone destruction may simulate slow growing bone tumor or tumor-liked lesion e.g. giant cell tumor, chondromyxoid fibroma, cartilaginous tumor, etc.
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Radiographic Pseudo-tumor
Insufficiency fractures Can have ill-defined lytic appearance on
plain radiograph and may mimic bone metastasis
Background of decreased bone density, evidence of fracture lines on CT or MRI, and other insufficiency fractures with irregular sclerotic lines at typical locations are helpful diagnostic clues.
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Radiographic Pseudo-tumor
Hemophiliac pseudotumor Secondary to repetitive bleeding into the bone Affected bones in order of frequency : femur,
pelvis, tibia and small bones of hands Well-defined, unilocular or multilocular
expanding lytic lesion of variable size May show endosteal scalloping, cortical thinning
or thickening, traversing trabeculae or septaliked structure, peripheral sclerosis
Progressive expansion may lead to deformity or pathologic fracture
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Radiographic Pseudo-tumor
Metabolic disease Brown tumor can mimic benign bone
tumor but other radiographic findings of hyperparathyroid should guide the correct diagnosis
Skeletal amyloidosis can manifest as aggressive expansile lytic lesion simulate tumor, commonly encountered at the hip and shoulder