© Department of Continuing Medical Education, Christian Medical College, Vellore
For more information please email: cme@cmcvellore.ac.in

Learning Cases April 2005

STUDY 1: ORTHOPAEDICS - CASE OF THE MONTH

A girl with bowing of legs

Courtesy: Department of Orthopaedics, CMC, Vellore.

HISTORY

This 7 year old girl was noticed to have a minor bowing of tibia at the age of 2 years. Since then the leg has been bowing gradually She has no pain and is able to walk normally. Her clinical photographs and Xrays at the age of seven years are shown below:

Click on the pictures to enlarge.

1. What are the findings?

   The radiographs show radoiolucent lesion with a rim of reactive bone. The radiological picture is classical and usually biopsy is not required.
   
   

2. What is the diagnosis?

   This is osteofibrous dysplasia also sometimes called ossifying fibroma. Some authors believe that this is a variant of fibrous dysplasia though this is controversial. This lesion is seen classically in the upper tibia, involving the anterior cortex and creates an anterior bowing or mass. It is benign but locally aggressive.
   
   

3. Where else in the body is this lesion found?

   Mandible is the other classical site for this lesion.
   
   

4. What is the treatment of this lesion?

   Complete excision and bone grafting for such a large lesion is required.
   
   

5. How will you treat a smaller lesion in a child?

   Under 1 years of age a small lesion can be treated with bracing Larger lesion and lesion after physeal closure require complete excision and bone grafting.
   
   

6. What is the major problem with this lesion?

   Lesion tends to recur and in person older than 10 years diagnosis of adamantinoma needs to be considered.
   
   

Acknowledgement: Submitted by Dr. Vrisha Madhuri, Professor, Dept. of Orthopaedics, CMC, Vellore.

Top

STUDY 2: RADIODIAGNOSIS - CASE OF THE MONTH

Spot the diagnosis

Courtesy: Department of Radiodiagnosis, CMC, Vellore.

HISTORY
A 45 year old obese lady presented with
• Fatigue, weakness
• Weight gain
• Cold intolerance
• Coarse, dry hair
• Rough skin
• Constipation
• Depression
• Memory loss
• Abnormal menstrual cycles

INVESTIGATIONS

• T4 - low
• TSH - high

Click on the picture to enlarge.





1. What are your findings on this CT- scan?

   Bilateral symmetric calcification involving the basal ganglia and dentate nucleus.

2. What is your differential diagnosis?

   Hypoparathyroidism; Hyperparathyroidism; DD include Fahr’s disease.
   
   

3. What is your diagnosis?

   Hypothyroidism




Acknowledgement: Submitted by Dr. Sudheer, Department of Radiodiagnosis, CMC, Vellore.

Top

---

Send response