0:00

Another case here, so I'll let you look at these

0:04

images and we'll have a question with this case.

0:08

These are the coronal T2 FAT

0:10

sat images, coronal T1 images.

0:15

The scan is of a young girl,

0:16

16-year-old, with knee pain.

0:25

This is the axial T2 FAT sat.

0:30

So can we have the question, please?

0:33

So what is the diagnosis and

0:34

cause of pain in this condition?

0:36

Your options are MHE malignant transformation, MHE

0:39

bursitis, Ollier's syndrome, and there's hemangioma,

0:43

Maffucci's syndrome, and there's hemangioma.

0:47

Let's see what the answers are.

0:50

MHE bursitis, that's the correct answer.

0:53

So going back to the case, here we see

0:57

remodeling of the distal femur, proximal tibia.

0:59

There is this wiping of the metaphysis,

1:02

and we see these small bony projections.

1:05

So these are multiple small osteochondromas that

1:07

make the diagnosis of multiple hereditary exostosis.

1:11

And here we have the other lesions,

1:14

if you see, they have a nice thin cartilage

1:17

cap around them like this lesion here.

1:22

But this one is more like a fluid

1:24

collection with debris in it.

1:26

So, and as we know, one of the complications

1:28

that these osteochondromas can cause is bursitis.

1:31

So the cause for pain in this case again was bursitis.

1:35

But again, this is a patient with MHE,

1:37

so we need to follow these up closely

1:39

because there is a higher risk for

1:41

malignant transformation in these cases.

1:44

So for MHE, uh, the important thing to

1:47

remember is, uh, that it can result in growth

1:49

retardation and artificial widening, which is

1:51

caused by disruption of normal bone tubulation.

1:55

And the most dreaded complication in these

1:59

cases is malignant degeneration, and it's much

2:01

higher as compared to, um, the risk of malignant

2:04

degeneration in a solitary osteochondroma. Up to 3 to 5%

2:07

of patients will develop malignant transformation

2:10

with the mean age of onset of 31 years.

2:12

Um, the osteochondromas can be sessile or pedunculated,

2:15

and the osteochondromas continue to grow until the child

2:18

reaches skeletal maturity, and some may even

2:21

show spontaneous regression.

2:23

So to summarize, how do we make

2:25

a diagnosis of osteochondroma?

2:27

It's easy when you see a bone projection with

2:29

corticomedullary continuity. We should be aware

2:32

of some of the complications that it can cause.

2:34

It can cause complex bursitis because of friction.

2:37

It can compress the adjacent nerves and vessels.

2:41

It can fracture, and the most dreaded

2:43

complication is malignant transformation.

2:45

And it's important to measure

2:46

the cartilage gap in those cases.

2:48

And, uh, if you see multiple osteochondromas, um, those

2:52

patients usually have multiple hereditary exostoses.

2:55

An important thing to remember is they can cause

2:57

growth disturbances, uh, skeletal deformities

3:00

that will require correction, and there will be a

3:02

higher chance of malignant transformation in these cases.