111/572. Wear debris associated with a large lateral femoral condyle cyst following an Oxford medial unicompartmental knee replacement. A 63-year-old gentleman presented with a history of worsening left knee pain almost 5 years following bilateral uni-compartmental knee replacements. x-rays revealed a fracture of the medial tibial plateau and revision surgery was undertaken. A large cyst was found in the lateral femoral condyle, which extended from the weight bearing area in the lateral compartment to the margin of the trochlea. histology of the lesion revealed a central degenerate cyst with multiple particles of polyethylene and cement debris around its periphery. Cyst progression in association with wear debris is a rare problem following unicompartmental knee replacement. The findings at the time of revision in this case demonstrate that the complications of unicompartmental arthroplasty may affect all compartments of the knee. ( info) |
112/572. Atypical pulmonary giant hydatid cyst as bilaterally symmetrical solitary cysts. A pulmonary giant hydatid cyst, a special clinical entity, is rare. Our case involves a young patient who presented with a bilaterally symmetrical solitary cyst in each lung, a feature consistent with congenital lung cysts. The radiological and immunological findings were equivocal. A diagnosis of giant hydatid cyst was made intraoperatively and both cysts were removed conservatively. A follow-up showed complete recovery. ( info) |
113/572. Aneurysmal bone cyst of the hyoid. Aneurysmal bone cyst is a rare lesion usually of the long bones, well documented in the literature. It is a cystic, osteolytic vascular tumour, replete with giant cells and fibrous septa, yet devoid of endothelial lining. It has been reported in the larynx and maxillary sinus. This appears to be the first report of an aneurysmal bone cyst occurring in the hyoid bone. ( info) |
114/572. Subchondral cyst of the tibia secondary to Wilson disease. We present the case of a 40-year-old male patient who had been suffering from Wilson disease for over 20 years, whose knee was diagnosed as osteoarthritis combined with subchondral cyst of the tibia. Preoperative examinations (X-ray, CT and MRI) confirmed the diagnosis. The microscopic examination detected thickening of the synovial membrane, and histopathological findings revealed that lymphoid cells and plasma cells were infiltrated at the synovial membrane. On copper-specific staining, no copper pigmentation was identified. However, the energy-dispersive X-ray (EDX) microanalysis revealed copper pigmentation in high concentration. These findings may contribute to our better comprehension of the development process of the arthropathy in patients with Wilson disease. The combination of subchondral cyst with Wilson disease is extremely rare, as only about 16 such cases have been reported in the English literature. ( info) |
115/572. Subperiosteal ganglion associated with Paget's disease of bone. Tumoral lesions related to Paget's disease may be classified as malignant, benign or pseudotumoral. While sarcomatous degeneration is the most feared complication, awareness of benign and pseudotumoral lesions is essential for assisting in accurate histological interpretation of the biopsy sample, which may avoid unnecessary repeat biopsies. We present the first case of a juxta-articular subperiosteal ganglion associated with Paget's disease, with classic imaging characteristics, especially on CT examination. The well-defined soft tissue mass at the medial aspect of the obturator rim, adjacent to a small fracture in pagetic quadrilateral plate, showed an ossified rim and internal gas lucencies, these being the hallmarks of a juxta-articular subperiosteal ganglion. On MRI, the lesion was of intermediate signal intensity on T1-weighted sequences, increased signal intensity on T2-weighted sequences, with rim enhancement after gadolinium contrast injection and preservation of fatty marrow signal of the underlying pagetic bone. Identification of the entity avoided an unnecessary biopsy or surgical intervention. ( info) |
| BACKGROUND: Simple bone cysts of the calcaneus are relatively uncommon. There is no clear consensus on either their etiology or management. Pathological fractures of such cysts are exceptionally rare. MATERIALS AND methods: Five simple bone cysts of the calcaneus were present in three males and two females with an average age of 44 years. One patient presented with pain, three cysts were incidental findings on ankle radiographs, and one patient presented with a fracture after a significant fall. RESULTS: All five were managed nonoperatively and had satisfactory outcomes. CONCLUSIONS: A review the literature on the etiology and management of simple bone cysts of the calcaneus and the outcomes of these patients indicate that complications of these cysts are rare and nonoperative management is appropriate. ( info) |
117/572. Brown tumor of the femur associated with double parathyroid adenomas. Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed. ( info) |
118/572. Pathologic fracture through a unicameral bone cyst of the pelvis: CT-guided percutaneous curettage, biopsy, and bone matrix injection. Unicameral bone cysts of the pelvis are extremely rare. A 19-year old man presented with a pathologic fracture through a pelvic unicameral bone cyst. He was treated with computed tomography-guided percutaneous curettage, biopsy, and demineralized bone matrix injection. Treatment has proven successful in short-term follow-up. ( info) |
119/572. Fluoroscopic imaging for technically difficult spinal anesthesia. We report a case of technically difficult spinal anesthesia in a morbidly obese woman, which was successfully implemented under fluoroscopy. Although radiological imaging is well known to guide various regional anesthetic procedures, until now, the utility of fluoroscopic imaging to facilitate spinal anesthesia had not been reported. ( info) |
120/572. Chronic subperiosteal hematic cyst formation twelve years after orbital fracture repair with alloplastic orbital floor implant. An 89-year-old female patient with a history of a left orbital floor fracture repair with synthetic implant 12 years prior, presented with a three-week history of blurry vision, inferior conjunctival chemosis and proptosis of the left eye. CT scan revealed a well-circumscribed subperiosteal lesion with superior elevation of the orbital floor implant. The patient underwent transconjunctival orbital surgery with removal of the implant and drainage of the subperiosteal hemorrhagic cyst. The patient had an uncomplicated postoperative course, with resolution of the proptosis, chemosis, and return of normal vision. This case represents an unusual late complication of orbital fracture repair with associated reduced visual acuity. ( info) |