Fibrodysplasia ossificans progressiva in a 3-year-old female patient / Fibrodisplasia osificante progresiva en una paciente de 3 años

Abstract Background: Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease affecting connective tissue, primarily caused by de novo mutations of the ACVR1 gene. FOP is a disease with congenital malformations of the toes and heterotopic ossification in characteristic patterns that progresses with flare-ups and remissions. Cumulative damage results in disability and, eventually, death. This report aimed to describe a case of FOP to highlight the importance of early diagnosis of this rare condition. Case report: We describe the case of a 3-year-old female diagnosed with congenital hallux valgus, who initially presented with soft tissue tumors, predominantly in the neck and chest, with partial remission. Multiple diagnostic tests were performed, including biopsies and magnetic resonance imaging, with nonspecific results. We observed ossification of the biceps brachii muscle during evolution. The molecular genetic study found a heterozygous ACVR1 gene mutation that confirmed FOP. Conclusions: Knowledge of this rare disease by pediatricians is critical for an early diagnosis and for avoiding unnecessary invasive procedures that may promote disease progression. In case of clinical suspicion, performing an early molecular study is suggested to detect ACVR1 gene mutations. The treatment of FOP is symptomatic and focused on maintaining physical function and family support.

Resumen Introducción: La fibrodisplasia osificante progresiva (FOP) es una enfermedad autosómica dominante rara que afecta el tejido conectivo, cuya causa principal son mutaciones de novo del gen ACVR1. Se trata de una enfermedad con malformaciones congénitas de los primeros ortejos y osificación heterotópica en patrones característicos que progresa en empujes y remisiones. El daño acumulativo provoca discapacidad y, eventualmente, la muerte. El objetivo de este trabajo fue describir un caso de FOP para favorecer el diagnóstico precoz de esta enfermedad infrecuente. Caso clínico: Se describe el caso de una paciente de 3 años, portadora de hallux valgus congénito, que inicialmente presentó tumoraciones dolorosas de tejidos blandos, de predominio en cuello y tórax, con remisión parcial de las mismas. Se realizaron múltiples pruebas diagnósticas, incluyendo biopsias e imágenes de resonancia magnética con resultados inespecíficos. En la evolución se observó osificación de músculo bíceps braquial. El estudio genético molecular encontró una mutación del gen ACVR1 en heterocigosis que confirmó el diagnóstico de FOP. Conclusiones: El conocimiento de esta enfermedad por los pediatras es clave para realizar un diagnóstico precoz y evitar procedimientos invasivos innecesarios que pueden promover la progresión de la enfermedad. Ante la sospecha clínica, se sugiere realizar tempranamente el estudio molecular para detectar mutaciones del gen ACVR1. El tratamiento de la FOP es sintomático, centrado en el mantenimiento de la función física y el apoyo familiar.

STIFF ELBOW!! POST TRAUMATIC MYOSITIS OSSIFICANS? A CASE REPORT

Myositis Ossificans is defined as Ossification of Haematoma around a joint resulting in formation of bone mass leading to restriction of joint movements completely in majority of cases. This is also known as Heterotopic Ossification, Ectopic Ossification. It is pathological bone formation in soft tissues especially in between muscle planes. It is extensive, progressive benign lesion occurring most commonly in fiexor muscles of arm, quadriceps muscles, adductor muscles of hip joint in young active adults and athletes [2,3,10] . Massage following trauma is the most aggravating factor of Myositis Ossificans. We report a case of 12 year boy with complaining of stiff elbow since 9 months, restricted elbow joint movements with history of fall while playing 1 year back for which he had taken treatment from local quack with aggressive massaging. There is fixed fiexion deformity of 90°. Clinical examination revealed a palpable bony mass on anterior aspect of elbow and Radiological investigation revealed ossified bony mass bridging elbow joint. Surgical Excision is done and biopsy showed mature stage Myositis Ossificans trabecular bone. Elbow range of movements started and patients has good range of movements with 1 year follow up with good physiotherapy

Miositis osificante progresiva: reporte de un caso / Progressive myositis ossificans: Case report

Introducción: la miositis osificante progresiva (MOP) es una enfermedad hereditaria del tejido conectivo de baja prevalencia (1:2,000,000 habitantes). Se caracteriza por osificación heterotópica con un comportamiento incierto que excepcionalmente se ha relacionado con neoplasias. Se buscó conocer la coexistencia de la MOP con neoplasias de origen mesodérmico, para que sean consideradas en el diagnóstico de otros pacientes, así como formular hipótesis para esclarecer su asociación. Caso clínico: mujer de 27 años con dolor de músculo isquitiobial y glúteo derecho que incrementaba con el ejercicio, sin remisión con analgésicos hasta limitar la movilidad de ambas extremidades. Se solicitó una serie ósea donde se evidenciaron zonas de radiolucidez heterogénea en la región de ambos muslos y pelvis de manera irregular, semejante a densidad ósea, que fue compatible con los hallazgos ecográficos y tomográficos; se concluyó que eran imágenes relacionadas con miositis osificante de cadera. La paciente refirió sintomatología gástrica y se solicitó una endoscopía que histopatológicamente reportó carcinoma gástrico difuso con células en anillo de sello; las imágenes de gabinete mostraron tumoración ovárica. Conclusión: la MOP es una patología de baja prevalencia, por lo que su conocimiento y sospecha son fundamentales para el diagnóstico. Hay poca literatura que involucre a las tres entidades; por ende, su fisiopatología y comprensión es limitada. En cuanto a la MOP, aún no hay un tratamiento curativo; sin embargo, el diagnóstico certero permite iniciar rehabilitación de manera oportuna con mejoría de la calidad de vida.

Background: Myositis ossificans progressiva (MOP) is a low prevalence hereditary connective tissue disease (1:2,000,000 habitants). It is characterized by heterotopic ossification with an uncertain behavior that has been exceptionally related to neoplasms. The objective was to know the coexistence of MOP with neoplasms of mesodermal origin, so that they can be considered in the diagnosis of other patients, as well as formulate hypotheses to clarify their association. Clinical case: 27-year-old female with right gluteal and ischitiobial muscle pain that increased with exercise, without remission with analgesics until limiting the mobility of both extremities. A bone series was requested where areas of heterogeneous radiolucency were evidenced in the region of, both, thighs and pelvis in an irregular manner, similar to bone density, which was compatible with the ultrasound and tomographic findings; we concluded that they were images of myositis ossificans of the hip. The patient reported gastric symptoms and an endoscopy was requested, which histopathologically reported diffuse gastric carcinoma with signet ring cells; cabinet images showed an ovarian tumor. Conclusion: MOP is a low prevalence disease, which is why its knowledge and suspicion are essential for the diagnosis. We found little literature that involves the three entities; therefore, their pathophysiology and understanding is limited. Regarding MOP, at this moment there is no curative treatment; however, an accurate diagnosis allows to start rehabilitation in a timely manner with an improvement in the quality of life.

Miositis osificante traumática en recién nacido: reporte de caso / Traumatic myositis ossificans in newborn: a case report

La miositis osificante traumática (MOT) es una enfermedad en la que ocurre osificación heterotópica en dos a cuatro semanas tras uno o múltiples traumatismos. El objetivo de este artículo es describir las características clínicas y radiológicas de un caso de MOT en un recién nacido (RN) después de la canulación intravenosa de vía periférica, poco frecuente en la práctica clínica en neonatología. Presentamos a un RN pretérmino de 33 semanas en que, a los 20 días de vida, se evidenció lesión tumoral en el tercio distal del antebrazo izquierdo de 3 cm por 2 cm, que no impresionaba dolor, ni limitación a la movilización, y en la que no había signos infecciosos. El resto del examen físico osteomuscular era normal. En la zona de lesión, tres semanas antes, se había instalado un catéter intravenoso periférico (CIVP). Una radiografía del antebrazo izquierdo demostró lesión calcificada al nivel de las partes blandas, sin disrupción de las estructuras óseas adyacentes; la ecografía del antebrazo reveló una imagen focal ovalada, de contornos parcialmente definidos, con sombra acústica posterior; el resto de los estudios de huesos largos era normal. Los niveles séricos de fosfatasa alcalina, calcio, fósforo también eran normales. En vista de la lesión tumoral al examen físico y la imagen calcificada en partes blandas a través de radiografía simple, con antecedente de microtraumas de VVP, se concluyó MOT. Se hizo seguimiento, con disminución del tamaño hasta que la lesión desapareció a los cuatro meses. No requirió control radiológico. La MOT es infrecuente en el RN, y, en general, la resolución es autolimitada y tiene buen pronóstico

Traumatic myositis ossificans (TMO) is a disorder in which heterotopic ossification occurs two to four weeks after one or multiple traumas. The goal of the present article is to describe the clinical and radiological characteristics of a case of TMO in a newborn (NB) after a peripheral intravenous cannulation, a rare procedure in the clinical practice of neonatology. The patient is a premature 33-week-old NB who, 20 days after birth, presented with a 3 cm x 2 cm lump in the distal third of the left forearm that did not seem to cause pain or to limit movements, and with no evidence of infection. The rest of the physical exam was within normal limits. Three weeks before the lesion, a peripheral intravenous catheter (PIVC) was placed in that area. A radiograph of the left forearm showed soft-tissue calcification without disruption of adjacent bone structures. Ultrasound revealed a focal, oval soft tissue lesion with partially-defined borders and posterior acoustic shadow; the rest of study showed normal long bones. The serum levels of alkaline phosphatase, calcium, and phosphorus were all normal. In view of the tumor lesion on the physical examination and the calcified image in softtissue on plain X-ray and a recent history of PIVC microtrauma, we reached to the diagnoses of TMO. During the follow-up, the lesion decreased in size until it completely disappeared four months after the diagnosis. No radiological control was needed. Uncommon in NBs, TMO is generally self-limited and with a good prognosis

Clinical, radiological, and molecular diagnosis of progressive fibrodysplasia ossificans / Diagnóstico clínico, radiológico y molecular de fibrodisplasia osificante progresiva

Abstract Background: Progressive fibrodysplasia ossificans is a rare genetic disease with heterozygous mutations (autosomal dominant inheritance) in the ACVR1 gene, which causes progressive heterotopic ossification in muscles, tendons, and ligaments, usually secondary to trauma. The ossification foci generate pain, joint ankyloses, and restricted movement. Congenital shortening and medial deviation first metatarsal of the foot is a distinctive feature. This report aimed to present an educational value case of a patient with clinical, imaging, and molecular diagnosis of progressive fibrodysplasia ossificans, recognized as a rare condition that severely affects the quality of life. Case report: We present the case of a 6-year-old female patient with lumps in the right scapular and dorsal region, progressive joint rigidity, and short first metatarsal medially deviated since birth. By imaging studies, we established the diagnosis of progressive fibrodysplasia ossificans. Sanger sequencing of ACVR1 reported c.617G>A (p.Arg206His). Conclusions: Confirmation of the diagnosis allowed genetic counseling, including a comprehensive explanation of the disease’s natural history and measures to prevent its rapid progression.

Resumen Introducción: La fibrodisplasia osificante progresiva es una enfermedad genética poco frecuente, causada por variantes patogénicas en estado heterocigoto (herencia autosómica dominante) en el gen ACVR1, que provoca osificación heterotópica progresiva en músculos, tendones y ligamentos, comúnmente secundaria a traumatismos. Los focos de osificación generan dolor, anquilosis articular y restricción del movimiento. Es característico el acortamiento congénito y la desviación medial del primer metatarsiano del pie. El objetivo de este reporte es presentar un caso de alto valor educativo de una paciente con diagnóstico clínico, imagenológico y molecular de fibrodisplasia osificante progresiva, reconocida como una condición infrecuente y que afecta de manera grave la calidad de vida. Caso clínico: Paciente de sexo femenino con tumoraciones induradas en la región dorsal y escapular, detectadas a los 6 años de vida. Cursaba además con rigidez articular progresiva y primer metatarsiano del pie acortado y con desviación en sentido medial desde el nacimiento. Por estudios de imagen se estableció el diagnóstico de fibrodisplasia osificante progresiva. Por secuenciación Sanger se reportó c.617G>A (p.Arg206His) en ACVR1. Conclusiones: La confirmación del diagnóstico permitió ofrecer un asesoramiento genético integral, incluyendo una amplia explicación de la evolución natural del padecimiento y de las medidas preventivas para disminuir su rápida progresión.

Non-traumatic myositis ossificans

Myositis ossificans (MO) is a benign, ossifying lesion that usually affects the skeletal muscle. The rare non-traumatic form of MO can cause diagnostic dilemma and management issues. These lesions, however, have similar radiology and histopathological characteristics described in the more frequently encountered traumatic forms. Depending on the stage of the lesion, the inherent feature of myositis ossificans varies, and so does the management of the lesion. We describe a non-traumatic MO occurring in latissimus dorsi of a young girl and discuss the review of literature on this rare subtype.

Hyperphosphatemic tumoral calcinosis: a rare differential of periarticular swelling

Tumour calcinosis is a rare clinical and histopathological syndrome characterised by deposition of calcium deposits in different periarticular soft tissue regions of the body. It mainly manifest in childhood/ adolescence as a painless, firm to hard tumour like mass around the joints. Most common regions involved: Shoulder, elbow and hip. An 18 year old male patient presented to the opd with a history of pain and swelling over his left hip since 2 months. On examination, there was a diffuse tender swelling over the left greater trochanter, skin over the swelling was normal with no discharge, no dilated/ engorged veins. Range of motion of left hip was normal, no limb length discrepancies. X-ray: Showed a well define calcified mass over the greater trochanter with no osseous involvement. MRI revealed an encapsulated hypointense mass present posterior to the greater trochanter, mostly in the muscular plane. Lab findings revealed mild hyperphosphetemia. An aspirate from the swelling showed casseousmaterial. En mass removal was done and sent for biopsy. Biopsy showed features suggestive of tumoral calcinosis. Tumoral calcinosis is a distinct clinico-radiopathological entity characterised by soft tissue periarticular calcinosis which mimics a true neoplasm, associated with elevated levels of serum phosphate. It is an extremely rare condition which is seen in the adolescence and requires more studies regarding the surgical and medical management of the same.

Fibrodisplasia osificante progresiva plus por una variante patogénica del gen ACVR1: caso clínico / Fibrodysplasia ossificans progressiva: report of one case

Fibrodysplasia ossificans progressiva (FOP) or myositis ossificans, is a genetic disease, with a prevalence of 1 in 2.000.000. It is caused by pathogenic variants in ACVR1 gene and characterized by soft tissue heterotopic ossification, starting in the second decade of life. It is associated to early mortality caused by respiratory complications. It evolves in flare-ups, triggered by soft tissue injuries; therapy is symptomatic, using analgesia, steroids and diphosphonates. We report a 12-year-old female with left renal agenesis, hallux valgus and intellectual disability, presenting with a six months history of thoracic kyphosis, tender nodules in the thorax, and rigidity of right elbow and left knee. Clinical examination revealed dysmorphic facial features. A magnetic resonance showed heterotopic ossification nodules, which was confirmed with spinal radiography. These findings prompted the diagnosis of FOP. Pain treatment was started, and prednisone was used during flare-ups. The ACVR1 gene was analyzed and a pathogenic variant, p. Arg206His, was found, confirming the diagnosis of FOP.

Musculoskeletal "don't touch" lesions: pictorial essay / Lesões musculoesqueléticas do tipo "não toque": ensaio iconográfico

Abstract Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.

Resumo O achado de lesões ósseas focais não é incomum no dia-a-dia do radiologista. É, portanto, imprescindível saber discernir as lesões com potencial maligno agressivo, que requerem ação, das desprovidas de significado clínico, muitas destas sendo variantes da normalidade ou processos reativos benignos, às vezes, autolimitados. Em alguns casos, a confusão diagnóstica pode ter resultados catastróficos, como a realização de biópsia em casos de miosite ossificante, que pode levar ao diagnóstico incorreto de lesões de origem sarcomatosa e a cirurgias mutilantes. O presente estudo faz uma revisão dos principais aspectos radiológicos das lesões que mais comumente são vistas no dia-a-dia e que possuem potencial para causar confusão com processos ósseos malignos e agressivos. Ilustramos, ainda, essas lesões, apresentando casos do nosso serviço.

Establishment of an Animal Model for Post-traumatic Myositis Ossificans of the Quadriceps Femoris / 中国运动医学杂志

Objective To establish the animal model of traumatic myositis ossificans through striking the quadriceps muscle of rabbits repeatedly.Methods Nine white adult New Zealand rabbits were selected,as their left lower limbs were used as the model group and the right lower ones served as controls.The left hind limbs were stricken by a 0.25 kg ball falling from a height of 100 cm every 3 days for and then immobilized with the knee in extension,while the right knees were immobilized in the same way without striking.The rabbits were sacrificed at the 4th,6th and 8th weeks respectively.The swelling,local physical signs and pathological changes of the heterotopic ossification had been assessed.Results The swelling of left quadriceps was obvious,with progressively stiffness of the left knees accompanied by distinctly palpable indurations,while in the right hind limbs,the joint was stiff but without indurations.The imaging examination showed the ossification began to appear in the impact sites of the model group at the 4th,6th and 8th weeks.The hematoxylin-eosin staining demonstrated that there was obvious cartilage or bone formation in the muscle tissues of the left quadriceps at the 8th weeks.Conclusion An animal model of post-traumatic myositis ossificans can be successfully established in rabbits through beating their quadriceps repeatedly.

Characteristics of the joint involvement in fibrodysplasia ossificans progressiva and follow up / 中华儿科杂志

Objective@#To summarize the clinical data of 15 patients with fibrodysplasia ossificans progressiva (FOP), follow up and analyze the characteristics of the joint involvement in FOP.@*Method@#From May 2005 to December 2016, fifteen FOP cases had been diagnosed in the Children′s Hospital Capital Institute of Pediatrics. All medical records and follow-up data were collected and a retrospective analysis was made on the joint involvement in FOP. Pearson correlation analysis was used for data, P<0.05 for the difference was statistically significant.@*Result@#There were 8 males and 7 females in 15 cases. The age of onset was 2(1-6)years. The age at diagnosis was 6 (4-9) years. All cases had hallux valgus deformity and bone mass formation. Twelve cases had joints involvement on enrollment into this study: 8 cervical vertebra, 7 shoulder joint, 5 hip joint, 4 elbow joint, 3 wrist joint, 2 temporomandibular joint, 2 lumbar vertebra. The age of diagnosis and duration of disease were positively correlated with the number of the involved joints (r=0.523, 0.628; P=0.045, 0.012); mild changes were found in joint imaging. Thirteen cases received telephone follow-up, the average duration of follow-up was 6(3-7)years, no change in 11 cases, disease progress in 2 cases.@*Conclusion@#Joint involvement is a common complication of FOP, especially the cervical vertebra.Multiple joints involvement, dominant functional impairment, and mild imaging changes are the characteristics of joint lesions caused by FOP.The number of involved joints gradually increases with increase of age of the patients and the prolonged course of the disease.

Case Report of Fibrodysplasia Ossificans Progressiva.

Fibrodysplasia ossificans progressiva is a rare genetic disease characterized by widespread soft tissue ossification and congenital stigmata of the extremities. We report a male patient who had bilateral hallux valgus since birth. Other noticed anomalies included multiple swellings over the back, stiffness of lower back area, multiple joints, restricting movement of spine, shoulders, elbows, and right hip and right knee. Patient was not able to bend forward, squat or turn head to either side. Patient also had multiple foci of ossification developed over left knee, and back region. All swellings and restrictions were painless.

Synovial Sarcoma Mimicking Myositis Ossificans

A calcification mass was incidentally found in the soft tissue of a patient who had a history of trauma to the extremity during examination. The patient had no symptom. The pathological analysis of the mass revealed it was an early-phase synovial sarcoma (SS). The diagnosis was made before the onset of symptoms and proper surgical intervention was performed. Therefore, in case of a <1 cm lesion clinically suspicious of myositis ossificans, SS should be taken into consideration as a possible diagnosis.

Myositis ossificans of the platysma mimicking a malignancy: a case report with review of the literature

The two main forms of myositis ossificans are congenital and acquired. Either form is rare in the head and neck region. The acquired form is often due to trauma, with bullying as a fairly common cause. This report of myositis ossificans of the platysma in an 11-year-old female patient emphasizes the need for a high index of suspicion in unexplainable facial swellings in children and the benefit of modern investigative modalities in their management.

Miositis osificante circunscrita bilateral de cadera en paciente con TEC severo complicado: caso clínico y revisión de literatura / Myositis ossificans circumscripta of bilateral hip in patient with severe complicated TBI: case report and literature review

To describe the pathology Myosistis ossificans circumscripta (MOC) in a patients with severe traumatic brain injury (TBI) complicated, emphasizing clinical features, imaging utility, surgery and postoperative prophylaxis with indomethacin. Introduction: MOC corresponds to heterotopic soft tissue calcification secondary to direct or repetitive trauma, in close relationship with TBI. The initial study is radiological, but computed tomography (CT) and magnetic resonance imaging (MRI) are the studies of choice. Case report: Male, 33 years old, polytraumatized with severe TBI complicated. That one year after his discharge from the hospital, beban with increased volume inguinocrural bilateral, progressive, compatible with bitateral MOC Brooker 4. Surgical resection im two stages, both with postoperative prophylaxis with Indomethacin. It evolved with excellent response, symtomatic remission without recurrence after two years of follow-up. Discussion: MOC is a rare disease, where the combined medical surgical management is of utmost importance when treating this disease and prevent recurrences...

Describir la patología Miositis Osificante Circunscrita (MOC) en paciente con traumatismo encéfalo craneano (TEC) severo complicado, enfatizando características clínicas, utilidad de imágenes, tratamiento quirúrgico y profilaxis postoperatoria con Indometacina. Introducción: MOC corresponde a la calcificación heterotópica de tejidos blandos secundaria a traumatismo directo o repetitivo, en estrecha relación con TEC. El estudio inicial es radiológico por tomografía computada (TC) y resonancia magnética (RNM), son los estudios a elección. Presentación de cado: Hombre, 33 años, politraumatizado, con TEC severo complicado. Que tras un año de alta comenzó con aumento de volumen inguinocrural bilateral, progresivo, compatible con MOC bilateral Brooker 4. Resección quirúrgica de dos tiempos, ambas con profilaxis postoperatoria con Indometacina. Evolucionó con excelente respuesta, remisión sintomática y sin recurrencias tras dos años de seguimiento. Discusión: MOC es una enfermedad infrecuente, donde el manejo médico-quirúrgico combinado es de suma importancia al momento de tratar esta patología y prevenir recurrencias...

Miositis osificante traumática de cadera bilateral / Bilateral hip traumatic myositis ossificans

RESUMEN La miositis osificante traumática es un proceso proliferativo, benigno, donde ocurre una metaplasia de tejido blando a hueso. El objetivo de este trabajo es presentar el caso de un paciente masculino de 17 años de edad con diagnóstico de miositis osificante postraumática en ambas caderas. A pesar de la rareza de dicha patología, su frecuencia puede ir creciendo debido al aumento de traumatismos de alta energía por accidentes de tránsito. Presentamos además una revisión bibliográfica sobre este tópico.

ABSTRACT Traumatic myositis ossificans is a proliferative benign process, where a metaplasia of soft tissue to bone occurs. The aim of this paper is to present the case of a 17-year-old male patient, diagnosed with traumatic myositis ossificans in both hips. Despite the rarity of this disease, its frecuency may increasedue to the increase in high energy trauma secondary to traffic accidents. We also present the literature review on this topic.

Osificación heterotópica neurogénica de la cadera en un paciente con trauma craneoencefálico grave / Neurogenic heterotopic ossification of the hip in a patient with severe traumatic brain injury

FUNDAMENTO: la osificación heterotópica es la formación de hueso ectópico y lamelar con médula ósea. La fisiopatología no se conoce en su totalidad. El tratamiento se basa en: antinflamatorios no esteroideos, radioterapia, bifosfonatos, cirugía y terapia física. OBJETIVO: presentar un caso de osificación heterotópica neurogénica de la cadera derecha como causa de limitación de la movilidad articular y ciática troncular. CASO CLÍNICO: paciente masculino de 28 años de edad con antecedentes de trauma craneoencefálico grave. Permaneció por más de dos meses encamado en estado crítico. Un año después comenzó con aumento de volumen de la región glútea derecha, dolor ligero en la pierna, que le dificultaba la posición de sentado, asociado a debilidad con predominio distal (pie péndulo), e hipoestesia. A la exploración física se constató masa tumoral en región glútea derecha de consistencia dura, pétrea, fija a planos profundos, no dolorosa con signo de Tinel positivo en la emergencia del nervio ciático. En la radiografía AP de la cadera derecha se pudo apreciar imagen ósea tumoral. Se comenzó tratamiento conservador sin mejoría, por lo que se realizó cirugía para resecar la masa ósea, obtener el diagnóstico histológico y mejorar la sintomatología. CONCLUSIONES: la osificación heterotópica es una complicación en pacientes con trauma craneoencefálico grave, el cuadro clínico no es específico y el diagnóstico es orientado por la imaginología y confirmado por la histopatología. El tratamiento quirúrgico ofrece los mejores resultados. La recurrencia se puede minimizar al combinar antiinflamatorios no esteroideos, radioterapia y rehabilitación.

BACKGROUND: heterotopic ossification is the formation of ectopic lamellar bone containing bone marrow. The physiopathology is not known in its entirety. The treatment is based on non-steroid anti-inflammatory drugs, radiotherapy, biphosphonates, surgery, and physical therapy. OBJECTIVE: to present a case of neurogenic heterotopic ossification of the right hip caused by limited articular mobility and truncal sciatica. CLINICAL CASE: a twenty-eight-year-old male patient with antecedents of severe traumatic brain injury. The patient stayed in bed for two months in a critical condition. A year later, his right gluteal region started to grow and he presented a slight pain in the leg that made him difficult to sit associated to debility with distal predominance (pendular feet) and hypoesthesia. In the physical examination, a tumor mass of hard consistence and fix to deep planes, painless with positive signs of Tinel in the emergence of the sciatic nerve, was found in the right gluteal region. In the radiography of the right hip, an osseous tumoral image was seen. A conservative treatment was started without any improvement, that's why a surgery was conducted to remove the osseous mass, obtain the histological diagnosis and improve the symptomatology. CONCLUSIONS: neurogenic heterotopic ossification is a complication that appears in patients with severe craniocerebral trauma. The clinical manifestations are not specific and the diagnosis is determined by means of imaging and confirmed through histopathology. The surgical treatment offers the best results. The recurrence can be minimized when combining non-steroid anti-inflammatory drugs, radiotherapy and rehabilitation.

Myositis ossificans traumatica of the left masseter muscle presenting as soft tissue mass: a case report.

Myositis ossificans is a rare disease in which manifests as heterotopic bone formation within a muscle and is rarely found in the head or neck regions, including the masticator muscle. It should be considered as a differential diagnosis in patients of trauma with severe limitation of jaw opening. Panoramic radiographs and axial and coronal computed tomography (CT) scans can effectively delineate the calcified mass. Other imaging studies that may be helpful include magnetic resonance imaging (MRI), bone scans, and ultrasound.

Imaging analysis of 45 patients with localized myositis ossificans / 实用放射学杂志

Objective To study the imaging characteristics of localized myositis ossificans for improving its diagnosis and differen-tial diagnosis ability.Methods The Clinical and radiographic data of 45 cases with localized myositis ossificans proved by pathology or clinical follow up were analyzed retrospectively,summarize its imaging features.Results Of the 45 cases,1 7 cases occurred in the elbow joint,1 5 in the hip joint,13 in the other parts of the body.X-ray showed lining or lamellar high-density ossification in soft tis-sues in 34 cases,of those 12 cases with “shell”ossification.Compared with the X-ray,CT showed more clear ossification.MRI showed the soft tissue mass with peripheral edema in 18 cases;3 cases obvious ossification,no edema around.SPECT/CT showed abnormal imaging agent concentration in soft tissue within 12 cases,of those 5 cases concentration range greater than the range of ossification,4 cases concentration range less than the range of ossification.Conclusion Localized myositis ossificans have certain im-aging characteristics.Integrated application of a variety of imaging combined with the clinical can fully display the evolution of the disease,and improve its diagnosis rate.

Fibrodisplasia osificante progresiva. Presentación de un caso / Fibrodysplasia Ossificans Progressive. A Case Report

Se presenta el caso de una niña de 3 años de edad llevada al Servicio de Imágenes Diagnósticas del Hospital de la Universidad del Norte (Barranquilla, Colombia) para una radiografía de tórax. Los hallazgos sugieren una formación de hueso inusual con Hallux Valgus bilateral al examen físico. Se hace también una revisión breve de la literatura de fibrodisplasia osificante progresiva (FOP).

3 year old female patient, who was admitted to Hospital de la Universidad Del Norte diagnostic imaging service, for a chest radiography. Findings were highly suggestive of the formation of unusual bones, with deformed big toes when undergoing physical examination. A brief review of the literature of Fibrodysplasia ossificans progressiva (FOP) is also performed.