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Case 253

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A 32-year-old male truck driver diagnosed with testicular cancer in 2013. He underwent surgery to remove the tumor and, due to complications, remained hospitalized for 3 months. He then underwent chemotherapy and bone scintigraphy, which showed no pattern indicative of bone metastasis. Previously healthy, he practiced physical activity regularly and denied comorbidities. Currently complaining of constant pain in the medial region of both thighs, worse on the left, with start 5 months ago. A new bone scintigraphy (99mTc-MDP) was requested.

Analyzing the clinical case and the findings of the scintigraphy, which is the most probable diagnostic hypothesis:

a) Osteomyelitis

25%

b) Cellulitis

25%

c) Ossific Myositis

25%

d) Metastases

25%
   

Image analysis

Image 1: Bone scintigraphy with 99mTc-MDP showing anomalous hypercaptation of the radiopharmaceutical in the rectus femoris and vastus medialis bilateral, more intense on the left.

Highlights

- Ossific myositis (OM) is a rare non-neoplastic condition characterized by proliferation of fibrous tissue and heterotopic bone formation.

- Approximately 75% of BM cases are associated with local trauma, more common in sports injuries.

- The laboratory changes are nonspecific.

- The most sensitive imaging test is bone scintigraphy. Computed tomography and simple radiography detect only late lesions, and magnetic resonance imaging is a useful method in the early stages.

- The treatment is eminently symptomatic, since the disease is usually self-limiting. Surgical excision, when indicated, is performed only when heterotopic ossification has already been established.

References

- AL-SALMI Ishaq, RANIGA Sameer, AL HADIDI Aymen. Fybrodysplasia Ossificans Progressiva – Radiological findings: A Case Report. Oman Medical Journal, Set. 2014; 29(5): 368-370.

- NUCCI Anamarli, QUEIROZ Luciano de Souza, SANTOS Allan de Oliveira, CAMARGO Edwaldo E, MOURA-RIBEIRO M Valeriana L. Fibrodysplasia ossificans progressiva: case report. Arq. Neuro-Psiquiatr.[Internet].2000  June [cited  2016  Aug  31] ;  58( 2A ): 342-347. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2000000200023&lng=en. http://dx.doi.org/10.1590/S0004-282X2000000200023.

- RANDALL Lor, WARD Russell e HOANG Bang H. Musculoskeletal oncology. In Current Diagnosis and Treatment in orthopedics. McGraw-Hill, 2014: 5th Ed.

- ZHANG Xianghonget al.Acquired heterotopic ossification in hips and knew following encephalitis: case report and literature review. BMC Surgery, 2014, 14:74. Available at: www.biomedcentral.com/1471-2482/14/74

- Walczak BE, Johnson CN, Howe BM. Myositis ossificans. J Am AcadOrthopSurg 2015;23:612-22.

- Lacout A, Jarraya M, Marcy PY, Thariat J, Carlier RY. Myositis ossificans imaging: keys to successful diagnosis. Indian J RadiolImaging. 2012;22:35-9.

Authors

André Ribeiro Guimarães, medical degree from Universidade Federal de Minas Gerais.

E-mail: guimaraesandrer[arroba]hotmail.com

 

Bárbara de Queiroz e Bragaglia, medical degree from Universidade Federal de Minas Gerais.

E-mail: barbara.bragaglia[arroba]gmail.com

 

Fábio Mitsuhiro Satake, 6th year medical student at Universidade Federal de Minas Gerais.

Email: fabiosatake[arroba]gmail.com

Supervisors

Soraya Ximene Carvalho Batista, resident physician in Nuclear Medicine of Hospital das Clínicas of UFMG.

Email: sorayaximene[arroba]yahoo.com.br

Reviewers

Lucas Raso, Raíra Cezar, Fernando Bottega and Professor Viviane Parisotto

Translated by

Laio Bastos de Paiva Raspante, 5th year medical student at Universidade Federal de Minas Gerais.

Email: laioopaiva[at]gmail.com

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