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short notes about Skeletal manifestations of eosinophilic granuloma (EG) summarized by Dr laith fadhel / radiologist
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Skeletal manifestations of eosinophilic granuloma (EG)
Presented by Dr.laith Fadhel
reference David Sutton 1340
• Epidemiology /The skeletal system is the commonest site of involvement of Langerhans cell histiocytosis, and in for 60-80% of cases is the only organ system involved.
• Aged affected / children 3-12 years / young adult / male predominance • location / skull , pelvis , femora , diaphysial predilection • Symptoms / pain , swelling , fever • Presentation / solitary , multiple lesions • Radiological sign / lucent area of bone distraction , Sharpe oval or scalloped margin , bone expansion , in chronic phase with sclerotic margin , collapse vertebra • DDX / osteomyelitis , Ewing's tumor , in spine / metastases , atypical TB , neuroblastoma
Skull
1. Isolated lesion 2. Bone expansion 3. Sharpe margin Oval ,
scalloped 4. DDX / epidemoid or
fibrous dysplasia
Spine
1. collapse vertebra { vertebra plana }
2. wall bulging laterally 3. disc intact 4. Para spinal soft shadow
Spine
1. collapse vertebra { vertebra plana }
2. wall bulging laterally 3. disc intact 4. Para spinal soft shadow5. CT / cortical erosion and
soft tissue involvement
Spine MRI / T1 - typically low signal T2 - isointense to hyper intense STIR - hyper intenseT1 C+ (Gd) - often shows contrast enhancement
PT Bone scanVariable appearance on bone scintigraphy with lesions showing an increased or decreased tracer uptake depending on the histological picture. Nonetheless bone scans are helpful in other asymptomatic lesions.