Learning objectives
The aim of this poster is to presenttheimaging characteristics oftypical skeletal "don't touch" lesions (also known as "leave me alone" lesions) that do not require additional diagnostic exploration for the finaldiagnosis.
With that in mind,
further action to distinguish the nature of the lesion,
such as biopsy,
is needless and inappropriate.
Background
These lesions can be divided into three subcategories:
1.
Post-traumatic lesions
a.
Myositis Ossificans
- trauma is the main cause
- more often in paraplegics (knees and hips)
- benign process of heterotopic areas of ossification within large
muscles of the extremities
- ability to mimic more aggressive pathological processes
(osteosarcoma)
- clinical features: sore swelling of soft tissues of the elbow and the
upper arm
- radiological features: circumferential calcification with radiolucent
center and radiolucent cleft (string sign) that separates the lesion from
the...
Findings and procedure details
There are different imaging modalities that can provide the final diagnosis.
Mostly,
radiography is the first and definitive diagnostic method.
Rarely,
the additional superior imaging modalities are necessary,
such as computed tomography (CT) and magnetic resonance imaging (MRI).
Most frequently "don't touch" lesions are incidental findings.
Conclusion
The additional diagnostic tests could often be misleading.
Unnecessary surgical removal could leave to equivocal histological appearance and postponed diagnosis of the lesion,
but also to unwanted morbidity and cost.
In addition,
due to the radiological highly distinctive features,
radiologists should be able to identify previously mentioned lesions as benign without considering further histological verification.
Personal information
Matko Gulin,
MD
Matej Mustapic,
MD,
PhD
Department of Diagnostic and Interventional Radiology
University Hospital Centre Sisters of Mercy
Vinogradska 29
10000 Zagreb
Croatia
References
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Brant WE,
Helms C.
Fundamentals of Diagnostic Radiology.
4th edition.
LWW; 2012
2.
Bohndorf K,
Imhof H,
Pope T.L.
Musculosceletal Imaging: A Concise
Multimodality Approach.
1st edition.
Thieme; 2001
3.
Berquist T.
MRI of the Musculosceletal System.
&th edition.
LWW; 2012