EURORAD ESR

Case 14705

Heterogenous fibrous dysplasia mimicking metastatic malignancy in patient with localised lung cancer

Author(s)
Blake Christianson BS1, Lorie Stumpo MD2, Yulia Melenevsky MD2, Janet Munroe MD2, Darko Pucar MD2

1 Medical College of Georgia, School of Medicine, Augusta University
2 Medical College of Georgia, Augusta University, Department of Radiology & Imaging

1120 15th Street,
BA-1411 30912 Augusta,
United States of America;
Email:dpucar@augusta.edu
 
Patient
female, 63 year(s)
 
 
  • Figure 1
    Initial FDG PET/CT
     

    Initial FDG PET/CT, whole body attenuation corrected MIP, demonstrating mild uptake (thin yellow circle) with a small intense component (thick red arrow) in left femoral intertrochanteric region.

     
    Area of Interest: Oncology; Imaging Technique: PET-CT; Procedure: Staging; Special Focus: Dysplasias;

    Fused axial images of the same FDG PET/CT in supine position demonstrating an indeterminate mildly active fibro-osseous lesion in the left femoral intertrochanteric region with an associated intensely hypermetabolic...

     
    Area of Interest: Musculoskeletal bone; Pelvis; Imaging Technique: PET-CT; Procedure: Screening; Staging; Special Focus: Dysplasias; Neoplasia;
     
     
  • Figure 2
    Axial MR Images
     

    T2FSE fat saturation axial MR depicts a hyperintense, non-fat containing lesion at the left femoral intertrochanteric region with posterior medial cortical thinning.

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Dysplasias; Neoplasia;

    T1FSE pre-contrast axial MR demonstrating the concerning lesion (red arrow), measuring 1.7x1.6x1.4 cm, at the left femoral intertrochanteric region with posterior medial cortical thinning.

     
    Area of Interest: Musculoskeletal bone; Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Screening; Special Focus: Dysplasias; Neoplasia;

    T1FSE fat saturation, post-contrast axial MR demonstrates avid enhancement of the same posterior heterogeneous lesion (red arrow).

     
    Area of Interest: Musculoskeletal bone; Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Screening; Special Focus: Dysplasias; Neoplasia;
     
     
  • Figure 3
    CT-guided biopsy
     

    Planning images for CT-guided biopsy (patient prone) depict the same fibro-osseous lesion with focal posterior nodule demonstrating cortical thinning. These homogeneously sclerotic, ground glass opacities of the...

     
    Area of Interest: Musculoskeletal bone; Pelvis; Imaging Technique: CT; Procedure: Biopsy; Diagnostic procedure; Special Focus: Dysplasias; Neoplasia;

    CT-guided biopsy with patient in the prone position depicting accurate needle position within the posterior aspect of the target lesion. These homogeneously sclerotic, ground glass opacities of the femoral neck are...

     
    Area of Interest: Musculoskeletal bone; Pelvis; Imaging Technique: CT; Procedure: Biopsy; Diagnostic procedure; Sampling; Special Focus: Dysplasias; Neoplasia;
     
     
  • Figure 4
    FDG PET/CT

    FDG PET/CT whole body attenuation corrected MIP, completed approximately 1 year after biopsy, again showing uptake in the left femoral intertrochanteric region.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: PET-CT; Procedure: Screening; Special Focus: Dysplasias; Neoplasia;
     
     
Initial FDG PET/CT, whole body attenuation corrected MIP, demonstrating mild uptake (thin yellow circle) with a small intense component (thick red arrow) in left femoral intertrochanteric region.
 
Fused axial images of the same FDG PET/CT in supine position demonstrating an indeterminate mildly active fibro-osseous lesion in the left femoral intertrochanteric region with an associated intensely hypermetabolic posterior nodule (red arrow).
 
T2FSE fat saturation axial MR depicts a hyperintense, non-fat containing lesion at the left femoral intertrochanteric region with posterior medial cortical thinning.
 
T1FSE pre-contrast axial MR demonstrating the concerning lesion (red arrow), measuring 1.7x1.6x1.4 cm, at the left femoral intertrochanteric region with posterior medial cortical thinning.
 
T1FSE fat saturation, post-contrast axial MR demonstrates avid enhancement of the same posterior heterogeneous lesion (red arrow).
 
Planning images for CT-guided biopsy (patient prone) depict the same fibro-osseous lesion with focal posterior nodule demonstrating cortical thinning. These homogeneously sclerotic, ground glass opacities of the femoral neck are classic for fibrous dysplasia.
 
CT-guided biopsy with patient in the prone position depicting accurate needle position within the posterior aspect of the target lesion. These homogeneously sclerotic, ground glass opacities of the femoral neck are classic for fibrous dysplasia.
 
FDG PET/CT whole body attenuation corrected MIP, completed approximately 1 year after biopsy, again showing uptake in the left femoral intertrochanteric region.
 
 
 
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