0:01

<v ->And the last case for this actually is a kid,

0:05

a 14-year-old girl

0:08

that came with a mass in the shoulder.

0:11

We can see in the plain film a soft tissue expansion here.

0:18

No calcification,

0:21

doesn't look like any articular stuff here.

0:24

And let's take a look

0:27

at the MR.

0:32

T1.

0:37

And T2 here.

0:41

So what can we see here

0:44

is that we have nodules

0:49

inside the subacromial bursa.

0:52

The bursa is distended by fluid,

0:54

but the nodules, they have a characteristic.

0:59

They have high signal intensity in the central part,

1:04

and they have a low signal on the periphery.

1:09

So this is very typical sign of a cartilaginous nodule.

1:15

And

1:20

also

1:22

the post-contrast showed no enhancement

1:26

of the nodule,

1:27

a lot of enhancement of the bursa

1:31

because of the inflammatory process.

1:35

If you wait after the injection of contrast,

1:39

the synovial will get the,

1:44

the inflamed synovial will get the contrast

1:46

inside the bursa, like indirect arthography,

1:49

so inject, wait a little bit.

1:51

So doesn't seem like you have vascular.

1:57

It's all inflammatory fluid here

1:59

and the thick wall.

2:02

And also we had some ganglion lymph nodes

2:09

near the trapezial muscle here.

2:14

And this turned out to be,

2:22

this turned out to be this,

2:27

this is a picture of the surgery

2:30

showing the nodules, the cartilaginous nodules,

2:33

bursal chondromatosis.

2:36

So it's an analogous to synovial chondromatosis,

2:40

but is a metaplasia of the bursal membrane.

2:44

So it's very, the pathogenesis is very similar, okay.

2:52

Don, that's all my last case of this session.

2:55

<v ->I'm just curious why they,

2:57

do you have a reason for why

2:59

there was lymph node enlargement?

3:04

<v ->No, that's a good question.

3:07

Because probably the inflammatory process,

3:11

not infectious, but inflammatory.

3:14

And after they did the surgery,

3:17

the lymph node, they disappeared.

3:19

I did not find good articles

3:23

about that entity on the literature.

3:25

I will try to publish this case here,

3:28

I think it's a unique case, this.

3:30

<v ->I think it's a good case.

3:31

And as you know, we had discussed it,

3:33

and I thought the differential for me

3:36

was whether that was tuberculous bursitis with rice bodies.

3:40

You know, and so, but that's a beautiful example,

3:43

and the surgery is very, very nice.