Robert R. Brown

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1996-1997

• Robert R. Brown
• Evelyne Fliszar
• Ingrid Kjellin
• Sandy Kwak
• Khanh Nguyen
• Thomas Rand
• Joong-Mo Ahn,

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Evelyne Fliszar

• 47 yo female, shoulder pain post fall

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47 yo female, shoulder pain post fall
Initial radiographs 9/05
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47 yo female, shoulder pain post fall
6 weeks later, 11/05
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47 yo female, shoulder pain post fall
Bone marrow edema Effusion Malalignment High
grade rotator cuff tear Osseous destruction
Coronal T2 w 11/05
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47 yo female, shoulder pain post fall
T2 Axial FS and post IV contrast
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47 yo female, shoulder pain post fall

• Joint aspiration was negative for infection

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47 yo female, shoulder pain post fall
Sagittal T2w of cervical spine, 2002
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47 yo female, shoulder pain post fall

• Final Diagnosis
• Neuropathic joint

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Evelyne Fliszar

• 34 yo male, hip pain following a fall down
  stairs. MRI done to rule out a fracture.

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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.
Axial and sagittal T2w images edema in iliopsoas
muscle
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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.
Axial T2w image
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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.

• 8 weeks following trauma, repeat MRI because of
  severe weakness in quadriceps muscle.

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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.
Axial T2w images muscle edema in pectineus,
sartorius and quadriceps
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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.
8 weeks following trauma, severe weakness in
quadriceps Axial T2w FS
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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.

• FINAL DIAGNOSIS
• Femoral nerve injury with denervation muscle
  edema

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34 yo male, hip pain following a fall down
stairs. MRI done to rule out a fracture.

• Other causes of femoral nerve injury
• Following iliopsoas hematoma
• Fracture of the acetabulum
• Surgery

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Ingrid Kjellin
Loma Linda University Medical Center, CA
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Ingrid Kjellin

• 7 year-old female with a left thigh mass. History
  of cardiac transplantation in infancy.

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7 year-old female with a left thigh mass. History
of cardiac transplantation in infancy.
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7 year-old female with a left thigh mass. History
of cardiac transplantation in infancy.
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7 year-old female with a left thigh mass. History
of cardiac transplantation in infancy.
PET
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PTLDPost-Transplant Lymphoproliferative Disorder

• Associated with Epstein-Barr virus infection
• Heterogeneous group of diseases after solid organ
  transplant
• WHO classification
• Early (reactive plasmacytic hyperplasia)
• Polymorphic PTLD
• Monomorphic PTLD (lymphomas)

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PTLDPost-Transplant Lymphoproliferative Disorder

• Related to degree and duration of
  immunosuppression, type of organ transplanted,
  CMV status
• Fever, adenopathy
• Extranodal disease in gt2/3 of cases (muscle
  involvement extremely rare)
• Excisional biopsy, multiple core needle biopsies,
  bone marrow biopsy, CT chest/abd/pelvis
• Rx Reduction of immunosuppression, antiviral,
  anti-B-lymphocyte antibodies (rituximab),
  interferon, chemotherapy
• Reported rates of cure/survival variable because
  of heterogeneity of disease

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PTLD

• Differential Smooth muscle neoplasms (leiomyoma,
  leiomyosarcoma) increased incidence in
  immunocompromised

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Ingrid Kjellin

• 59 year-old male with chronic renal failure,
  diabetes and hypertension. Recent left thigh pain
  and swelling. Had recent abdominal MRI/MRA

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59M
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59M
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Discussion

• Differential diagnosis
• Pyomyositis
• Necrotizing fasciitis
• Ischemia
• Polymyositis
• Scleroderma
• Nephrogenic systemic sclerosis

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Nephrogenic Systemic Sclerosis(Nephrogenic
Fibrosing Dermopathy)

• Rare multisystemic disorder in patients with
  renal insufficiency first described in 1997 (200
  cases reported to ICNFDR)
• Unknown etiology
• IV gadolinium may serve as a trigger in the
  setting of acute hepatorenal syndrome or
  dialysis-dependent chronic renal insufficiency
• Skin induration of extremities and trunk
• Myalgia, weakness
• Skin biopsy proliferation of fibroblasts
  adjacent to collagen bundles and absence of
  inflammatory cells

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Nephrogenic Systemic Sclerosis(Nephrogenic
Fibrosing Dermopathy)

• Systemic fibrosis with involvement of the
  skeletal muscle, bone, pleura, pericardium,
  myocardium, kidney, testes, dura
• At LLUMC 12 patients 2000-2006
• Skin fibrosis and joint contractures within 2-11
  weeks following double-dose iv gadodiamide

AJR 2007 188, February 2007
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Nephrogenic Systemic Sclerosis(Nephrogenic
Fibrosing Dermopathy)
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Nephrogenic Systemic Sclerosis
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Neprogenic Systemic Sclerosis

• Long term outcome Severe inability to ambulate
  due to contractures and myopathy, cane required
  for ambulation, no disability. Skin changes
  persist.
• Plasmapheresis may have some effect. Dialysis
  probably of no help.
• FDA issued a public health advisory in June 2006
  with regards to high-dose gadolinium-containing
  agents in patients with renal failure
• At LLUMC no iv gadodiamide in acute renal
  failure, hepatorenal syndrome, dialysis patients
  or ESRD with creatinine clearance of lt15 ml/min,
  no double/triple dose

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Neprogenic Systemic Sclerosis

• Screen patients with serum creatinine and
  calculated creatinine clearance prior to MRI with
  contrast if history of kidney disease, diabetes,
  or gt60 y.o

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