Answer for BIR CoW 11 Apr 2021
Atrophic Pseudoarthrosis of Tibia with bone marrow edema abutting the fracture ends
Findings
Fracture involving the junction of proximal 2/3 rd and distal 1/3 rd of left Tibia with atrophic fracture ends and anterolateral bowing STIR Hyperintensity reflecting bone marrow edema is noted in the fracture ends
Discussion
Congenital Pseudarthrosis of the Tibia ( CPT ) is characterized by segmental osseous weakness resulting in anterolateral angulation of the bone.50 % of the cases are associated with Neurofibromatosis Type 1 .Usually the disease becomes evident within a child’s first year of life. Bilateral occurrence is rare, the fibula is affected in one third of the patients. Crawford’s classification of CPT Patients with all types present with anterolateral bowing of tibia. In type I, the medullary canal is preserved. Cortical thickening might be observed. Type II is defined by presence of thinned medullary canal, cortical thickening, and tubulation defect. The dominant finding in type III is a cystic lesion, which may be fractured. In type IV, pseudarthrosis is present with tibial and possibly fibular nonunion. MR Imaging allows assessment of the type and extension of the disease. It is especially recommended for the evaluation periosteal and soft tissue changes near the pseudarthrosis
Reference: Andreas H. Mahnken, Gundula Staatz, Benita Hermanns, Rolf W. Gunther, Michael Weber :Congenital Pseudarthrosis of the Tibia in Pediatric Patients: MR Imaging
Findings
Fracture involving the junction of proximal 2/3 rd and distal 1/3 rd of left Tibia with atrophic fracture ends and anterolateral bowing STIR Hyperintensity reflecting bone marrow edema is noted in the fracture ends
Discussion
Congenital Pseudarthrosis of the Tibia ( CPT ) is characterized by segmental osseous weakness resulting in anterolateral angulation of the bone.50 % of the cases are associated with Neurofibromatosis Type 1 .Usually the disease becomes evident within a child’s first year of life. Bilateral occurrence is rare, the fibula is affected in one third of the patients. Crawford’s classification of CPT Patients with all types present with anterolateral bowing of tibia. In type I, the medullary canal is preserved. Cortical thickening might be observed. Type II is defined by presence of thinned medullary canal, cortical thickening, and tubulation defect. The dominant finding in type III is a cystic lesion, which may be fractured. In type IV, pseudarthrosis is present with tibial and possibly fibular nonunion. MR Imaging allows assessment of the type and extension of the disease. It is especially recommended for the evaluation periosteal and soft tissue changes near the pseudarthrosis
Reference: Andreas H. Mahnken, Gundula Staatz, Benita Hermanns, Rolf W. Gunther, Michael Weber :Congenital Pseudarthrosis of the Tibia in Pediatric Patients: MR Imaging
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!