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24b - Answer: 2-year-old female presents with multiple osseous lesions in left forearm

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 2-year-old female presents with multiple osseous lesions in left forearm.

(QUIZ ANSWER) MOST LIKELY DIAGNOSIS IN THIS CASE: 

Maffucci syndrome.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Multiple lesions with high fluid intensity involving the distal visualized humerus, radius, ulna, ossified carpal bones and metacarpals. The lesions appear extending from the metaphysis. There are foci of hypointensity within the lesions probably representing calcification. The largest one is in the distal radius and is expansile and multilobular in contour. The diameter is about 1.3cm with a thin tail extending to the metaphysis. Small linear fluid intensity at base of the olecranon probably early lesions. No periosteum inflammation. No adjacent soft tissue edema. 

A few lobular hyperintense lesions within the subcutaneous tissue. The largest one is about 7mm in diameter medial to the distal humerus. The findings are suspicious for hemangiomas. 

The muscles are normal in signal intensity. 

CONCLUSION: 

Multiple lytic lesions with probable calcification extending from the metaphysis most likely represent polyostotic enchondromas. A few lobulated lesions in the subcutaneous fat probably hemangiomas. The constellation of the findings may represent Maffucci syndrome. Probably Madelung's deformity. Will add an addendum after obtaining x-ray. 

ADDENDUM: 

Bone survey report, from one month prior, reviewed. The expansile radial lesion likely corresponding to the described osteochondromatosis in the radius.

LESSON 2, TOPIC 72

Case Challenge: Forearm MRI Cases

Case Challenge

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Content reviewed: July 19, 2021

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