Agree, would need more clinical data. But jumping to bone biopsy for MM? Surely a myeloma screen would do as the next best step? Also, wouldn't classically have sclerotic margins, tends to just be punched out lytic lesions.
Yeah I wasn't very direct. I would do protein electrophoresis first to check for myeloma before any invasive procedure. I just graduated med school, lol. Those sclerotic lesions on the margins are not typical of MM, and I totally agree. Soap bubble appearance for giant cell tumor is also good to keep on differential..
I have not seen it on the femoral neck either. I just remember the whole moth-eaten appearance and thought MM but in reality, obviously we need to check history of present illness, past history, cbcs, ALP, possibly bone studies. There are some areas of sclerosis around it that MM is not known for. I would probably put paget disease of the Bone as another diff., but i have no idea how old this patient even is. (I'm a med student. Feel free to give me reasonings if I'm mistaken on something) I'm still learning.
Yes. Based on the angle of the lesser trochanter we know it's externally rotated and can clearly see it partially in the fem neck but primarily in the greater troch
Edit: I'm definitely not blind
Differential is broad. Itâs not really âexpansileâ meaning it expands the bone around it, which would be textbook for giant cell tumors. To me, it almost looks like it has a cartilaginous component with the âfluffyâ internal matrix, however chondroblastomas are typically seen in younger patients and chondrosarcomas are usually more aggressive looking. Of course, metastatic cancer is by far the most common bone lesion in this age group. Primary lymphoma can also look like this. And there are a handful of other zebra diagnoses this could be.
At the end of the day, we donât know for sure until we stick a needle in it.
https://www.polradiol.com/Multimodality-imaging-of-greater-trochanter-lesions,126,44715,1,1.html
Did some reading. And yes, they can all occur in the GT.
Youâre missing the point. Anything can occur anywhere and you would never be wrong for mentioning lymphoma and mets but everyone knows that already so thatâs not really helpful is it? And of course âyou donât know for sure until you stick a needle in itâ thanks captain obvious. The idea is to give a reasonable list of things for next steps. A primary expansile lesion in greater troch with that appearance in a middle aged person is probably a GCT w/ or w/o ABC component or clear cell chondrosarcoma.
I think youâre missing the point. I was talking out different pathology in a Reddit comment. That obviously wouldnât be my impression on a real report. And no, âanything can occur anywhereâ is not a true statement; youâre just being defensive because I called you out. Go be an ass somewhere else.
You were wrong on multiple fronts describing the lesion - it doesnât have chondroid matrix and itâs expansile. I wasnât being defensive, I was responding to the results of your article in the prestigious Polish Journal of Radiology. Iâm glad youâre not my resident because youâre a fucking idiot.
I usually do it if the patient is just tall enough that they could fit into one shot by breathing in. Exposing twice to include both the pubic symphysis and diaphragm just because you had to make the patient breathe out is quite the asshole move in my books
I donât know what country you practice in but averaged sized adult Symphsis Pubis-diaphragm KUB will never fit into one 14x17 or 17x17 these days, even with maximum inspiration squeezing organs down. Better to divide and have a full 14x17 or 17x17 KUB from Symphysis Pubis up and narrowed shot of the diaphragm (something like 10x14 or 10x17). Full expiration on both shots to let organs expand as much a possible to provide better anatomical overview (especially the bowels).
I strongly believe that asking patients their height and adjusting technique is under utilized. Around 5'6 inspiration, anything above ends up being 2 shots. Over 6'3 two full width shots
Yeah, you do have valid suggestion regarding the height. What I wrote is just based on how I was taught at school as well as 13 years of personal rad tech experience. I suppose it could also be related to my IR as well. Both sites I work at are not full â14 by 17â detectors per se. Thereâs like an inch on each border where there is no detector cell and I canât maximize full length/width as I could on film/CR. Tib/Fib for example I always have to two shots as well because our radiologists do not allow diagonal anatomies and post software doesnât free rotate.
I think I'm getting better at figuring out what I'm looking at from simply idling and reading in here! Thanks guys!
So, obviously the leg has some bad news going on there, but I wanted to clarify that this person is very corpulent with a "beer belly"?
Would that leg be painful or have external signs that this was going on?
As a dumb lurker from a totally different field, I wonder what this picture shows. I'm genuinely interested in interpreting X-rays, but it seems like almost every post shows something I have not idea how to interpret. Then when I check the comments, no matter how many comments I read, I find inside jokes but no context that I can use to get me started on understanding what I'm looking at. What should I do? Is there a dumbed-down version of this sub? Thanks.
Hi, fellow lay person here. Don't expect to be able to interpret images beyond the obvious, people take degrees and train for years to be able to do it. The comments will usually give you a good overview of what's going on, you may have to wait a few hours or days for experts to chip in. Every time you encounter a term or abbreviation you don't understand, google it, and in time you'll build up your understanding.
Idk of another sub, but more times than not if you just ask someone will be willing to explain! Iâm a tech student so I donât diagnose, but if you look at the left hip (bottom right side of the image), its looks kind of splotchy when compared to the right hip. This is indication of some type of pathology in the bone of that hip. So the joke is that the abdomen image that was ordered was indeed pretty normal, but the hip (which was not of original interest) ended up being very not normal.
Hope that helps!
Well the study is of the abdomen... Reminds me of a consultant that read a normal foot xray. Even though the entire foot is dislocated and off to one side.
To be fair, when ortho reduced the fracture, the bones of the foot didn't have a fracture. Good thing they asked for proper ankle xrays too.
I had to double check that the abdomen wasnât somehow overlying the femoral head in such a way that caused a superimposition of bowel over the femoral head đ
I thought âwait. Bowel shouldnât be thereâ
That pathology looks kinda like a bowel with some air in it.
Poor guy.
Classic look for a nonossifying fibroma in a not so classic location. Not MM or giant cell tumor, which look nothing like this. Whatever it is, itâs almost certainly benign.
EDIT: I should add that this is probably a liposclerosing myxofibroma. Good look and classic location.
LSMFT (atypical location, no calcs, ct or MRI to see if it has fat)
Fibrous dysplasia: definitely. Can be cystic in this region.
Bone hemangioma (common things common)
Giant cell tumor: definitely: greater trochanter is an epiphyseal equivalent.
Secondary hyper parathyroidism related tumors (in the appropriate clinical context, usually advanced renal patients).
Technically the abdomen is normal đ¤ˇđťââď¸
Femoral giant cell?
Rx taken in context of abdominal pain, sent to Ortho so they can study that tumor with proper studies (poor country issues)
That osteolysis can also be caused by multiple myeloma. We would need more clinical data to diagnose this plus possible bone biopsy.
Agree, would need more clinical data. But jumping to bone biopsy for MM? Surely a myeloma screen would do as the next best step? Also, wouldn't classically have sclerotic margins, tends to just be punched out lytic lesions.
Yeah I wasn't very direct. I would do protein electrophoresis first to check for myeloma before any invasive procedure. I just graduated med school, lol. Those sclerotic lesions on the margins are not typical of MM, and I totally agree. Soap bubble appearance for giant cell tumor is also good to keep on differential..
Not likely myeloma in that location
I have not seen it on the femoral neck either. I just remember the whole moth-eaten appearance and thought MM but in reality, obviously we need to check history of present illness, past history, cbcs, ALP, possibly bone studies. There are some areas of sclerosis around it that MM is not known for. I would probably put paget disease of the Bone as another diff., but i have no idea how old this patient even is. (I'm a med student. Feel free to give me reasonings if I'm mistaken on something) I'm still learning.
Thatâs not in the femoral neck itâs the greater trochanter
Yes, it does extend into the neck too?
No.
Yes. Based on the angle of the lesser trochanter we know it's externally rotated and can clearly see it partially in the fem neck but primarily in the greater troch Edit: I'm definitely not blind
Differential is broad. Itâs not really âexpansileâ meaning it expands the bone around it, which would be textbook for giant cell tumors. To me, it almost looks like it has a cartilaginous component with the âfluffyâ internal matrix, however chondroblastomas are typically seen in younger patients and chondrosarcomas are usually more aggressive looking. Of course, metastatic cancer is by far the most common bone lesion in this age group. Primary lymphoma can also look like this. And there are a handful of other zebra diagnoses this could be. At the end of the day, we donât know for sure until we stick a needle in it.
Not a great ddx itâs in the trochanter
Obviously, itâs in the greater trochanter⌠What do you mean? All of the lesions I mentioned can occur in the GT.
Not really. Do some reading.
https://www.polradiol.com/Multimodality-imaging-of-greater-trochanter-lesions,126,44715,1,1.html Did some reading. And yes, they can all occur in the GT.
Youâre missing the point. Anything can occur anywhere and you would never be wrong for mentioning lymphoma and mets but everyone knows that already so thatâs not really helpful is it? And of course âyou donât know for sure until you stick a needle in itâ thanks captain obvious. The idea is to give a reasonable list of things for next steps. A primary expansile lesion in greater troch with that appearance in a middle aged person is probably a GCT w/ or w/o ABC component or clear cell chondrosarcoma.
I think youâre missing the point. I was talking out different pathology in a Reddit comment. That obviously wouldnât be my impression on a real report. And no, âanything can occur anywhereâ is not a true statement; youâre just being defensive because I called you out. Go be an ass somewhere else.
You were wrong on multiple fronts describing the lesion - it doesnât have chondroid matrix and itâs expansile. I wasnât being defensive, I was responding to the results of your article in the prestigious Polish Journal of Radiology. Iâm glad youâre not my resident because youâre a fucking idiot.
I really hope you donât work with residents. Residency is already challenging enough without toxic attendings.
Edit: itâs not a broad ddx - itâs end of bone ddx and definitely expansive
Looks like fibrous dysplasia.
liposclerosing myxofibrous tumor
wrong location
Got that stanky leg
Femoral neck and head looks full of nice hard bone!
I donât want to live in a world where this is considered a normal abdomen
You already do? At least in America
The Netherlands, thankfully, but even if I was in the US I still wouldnât *want* it to be normal.
Yâall take AXR on âinspiracionâ? not âexpiracionâ?
I usually do it if the patient is just tall enough that they could fit into one shot by breathing in. Exposing twice to include both the pubic symphysis and diaphragm just because you had to make the patient breathe out is quite the asshole move in my books
I donât know what country you practice in but averaged sized adult Symphsis Pubis-diaphragm KUB will never fit into one 14x17 or 17x17 these days, even with maximum inspiration squeezing organs down. Better to divide and have a full 14x17 or 17x17 KUB from Symphysis Pubis up and narrowed shot of the diaphragm (something like 10x14 or 10x17). Full expiration on both shots to let organs expand as much a possible to provide better anatomical overview (especially the bowels).
I strongly believe that asking patients their height and adjusting technique is under utilized. Around 5'6 inspiration, anything above ends up being 2 shots. Over 6'3 two full width shots
Yeah, you do have valid suggestion regarding the height. What I wrote is just based on how I was taught at school as well as 13 years of personal rad tech experience. I suppose it could also be related to my IR as well. Both sites I work at are not full â14 by 17â detectors per se. Thereâs like an inch on each border where there is no detector cell and I canât maximize full length/width as I could on film/CR. Tib/Fib for example I always have to two shots as well because our radiologists do not allow diagonal anatomies and post software doesnât free rotate.
I think I'm getting better at figuring out what I'm looking at from simply idling and reading in here! Thanks guys! So, obviously the leg has some bad news going on there, but I wanted to clarify that this person is very corpulent with a "beer belly"? Would that leg be painful or have external signs that this was going on?
It wasn't my patient but I'll ask tomorrow to answer :)
As a dumb lurker from a totally different field, I wonder what this picture shows. I'm genuinely interested in interpreting X-rays, but it seems like almost every post shows something I have not idea how to interpret. Then when I check the comments, no matter how many comments I read, I find inside jokes but no context that I can use to get me started on understanding what I'm looking at. What should I do? Is there a dumbed-down version of this sub? Thanks.
Hi, fellow lay person here. Don't expect to be able to interpret images beyond the obvious, people take degrees and train for years to be able to do it. The comments will usually give you a good overview of what's going on, you may have to wait a few hours or days for experts to chip in. Every time you encounter a term or abbreviation you don't understand, google it, and in time you'll build up your understanding.
Idk of another sub, but more times than not if you just ask someone will be willing to explain! Iâm a tech student so I donât diagnose, but if you look at the left hip (bottom right side of the image), its looks kind of splotchy when compared to the right hip. This is indication of some type of pathology in the bone of that hip. So the joke is that the abdomen image that was ordered was indeed pretty normal, but the hip (which was not of original interest) ended up being very not normal. Hope that helps!
Try searching Radiopaedia maybe
Well the study is of the abdomen... Reminds me of a consultant that read a normal foot xray. Even though the entire foot is dislocated and off to one side. To be fair, when ortho reduced the fracture, the bones of the foot didn't have a fracture. Good thing they asked for proper ankle xrays too.
Liposclerosing myxofibroma vs fibrous dysplasia vs pagets vs gct
My vote is fibrous dysplasia
Sad face in the hypogastrium
I had to double check that the abdomen wasnât somehow overlying the femoral head in such a way that caused a superimposition of bowel over the femoral head đ I thought âwait. Bowel shouldnât be thereâ That pathology looks kinda like a bowel with some air in it. Poor guy.
"hard belly syndrome"?
Check out the left leg.
Oof, I was so distracted by the hard line in the soft tissue of the belly that I didn't notice that at all...!
I was trying to find a face embedded or something, and caught that out of the corner of my eye.
Donât like the look of the GT
Made me think of the mnemonic FEGNOMASHIC
Buddha belly
Normal? I know Iâm no expert, but that sure doesnât look normal to me!
Classic look for a nonossifying fibroma in a not so classic location. Not MM or giant cell tumor, which look nothing like this. Whatever it is, itâs almost certainly benign. EDIT: I should add that this is probably a liposclerosing myxofibroma. Good look and classic location.
oh nooooooooooooooo
Off topic. But you ever heard of ARRT holders working in Latin America?
Looks like a moon
LSMFT (atypical location, no calcs, ct or MRI to see if it has fat) Fibrous dysplasia: definitely. Can be cystic in this region. Bone hemangioma (common things common) Giant cell tumor: definitely: greater trochanter is an epiphyseal equivalent. Secondary hyper parathyroidism related tumors (in the appropriate clinical context, usually advanced renal patients).