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What Do My CT Scan And MRI Reports Indicate?
Question: Hi,
Patient was experiencing pain in ribs for 10 years.
Please find below the reports:
10 Year Old XRAY Report:
Fibrous Dysplasia noted in right 3rd rib
Recent Reports:
XRAY REPORT:
============
Right 2nd and 3rd ribs shows ill defined sclerotic lesions in antero lateral aspect.
Small lytic area are noted within.
No other focal lesion in the visualized bones
No evidence of fracture
Lungs are clear
Hila are normal
CP angles are clear
Domes of Diaphragm are normal
Impression:
Recommended clinical correlation and further evaluation
CT CHEST/RIBS FINDINGS:
==================
Anterior chest wall deformity is noted on the right.
The 2nd and 3rd right anterior ribs are expanded and demonstrate multiple lytic foci with evidence of cortical erosion.
There is associated soft tissue thickening and stranding in the intercostal regions.
Rest of the ribs, sternum and the other visualised bones are within normal limits.
Dependent changes are seen in the lungs.
No focal lung lesion is seen.No pleural abnormality.
No significant upper abdominal abnormality.
MRI OF THE CHEST FINDINGS:
===================
Correlation is made with the CT performed on the same day.
MRI confirms the presence of expansile lytic lesions in the right 2nd and 3rd anterior ribs with associated soft tissue components.
Unremarkable appearances of the sternoclavicular joints.
IMPRESSION:
Expansile, lytic lesions in the right sided 2nd and 3rd anterior ribs with associated soft tissue thickening/oedema. Appearances are suggestive of an infectious etiology. Suggest biopsy for confirmation.
FNAC Report
========
US guided FNA of right anterior chest wall swelling involving 2nd and 3rd ribs
Smears are predominantly haemorrhagic consisting of few muscle fragments and few inflammatory cells. Epithelioid cell granuloma or malignant cells are not present.
Initially AKT4 was given for 2 months which increased the bone pain immensely. She is now off AKT4 and the pain has gone down considerably. What should be our next steps ? What might be the possible reason for this pain and what should be the treatment ?
Patient was experiencing pain in ribs for 10 years.
Please find below the reports:
10 Year Old XRAY Report:
Fibrous Dysplasia noted in right 3rd rib
Recent Reports:
XRAY REPORT:
============
Right 2nd and 3rd ribs shows ill defined sclerotic lesions in antero lateral aspect.
Small lytic area are noted within.
No other focal lesion in the visualized bones
No evidence of fracture
Lungs are clear
Hila are normal
CP angles are clear
Domes of Diaphragm are normal
Impression:
Recommended clinical correlation and further evaluation
CT CHEST/RIBS FINDINGS:
==================
Anterior chest wall deformity is noted on the right.
The 2nd and 3rd right anterior ribs are expanded and demonstrate multiple lytic foci with evidence of cortical erosion.
There is associated soft tissue thickening and stranding in the intercostal regions.
Rest of the ribs, sternum and the other visualised bones are within normal limits.
Dependent changes are seen in the lungs.
No focal lung lesion is seen.No pleural abnormality.
No significant upper abdominal abnormality.
MRI OF THE CHEST FINDINGS:
===================
Correlation is made with the CT performed on the same day.
MRI confirms the presence of expansile lytic lesions in the right 2nd and 3rd anterior ribs with associated soft tissue components.
Unremarkable appearances of the sternoclavicular joints.
IMPRESSION:
Expansile, lytic lesions in the right sided 2nd and 3rd anterior ribs with associated soft tissue thickening/oedema. Appearances are suggestive of an infectious etiology. Suggest biopsy for confirmation.
FNAC Report
========
US guided FNA of right anterior chest wall swelling involving 2nd and 3rd ribs
Smears are predominantly haemorrhagic consisting of few muscle fragments and few inflammatory cells. Epithelioid cell granuloma or malignant cells are not present.
Initially AKT4 was given for 2 months which increased the bone pain immensely. She is now off AKT4 and the pain has gone down considerably. What should be our next steps ? What might be the possible reason for this pain and what should be the treatment ?
Brief Answer:
Excision biopsy and bone scan will help.
Detailed Answer:
Hello,
Thanks for posting your query.
The expansile lytic lesion in the 2nd and 3rd rib can be due to an infection or due to fibrous dysplasia or a malignancy. FNAC done was inconclusive. Since the treatment with AKT has not helped, now she can go for a bone scan or a bone biopsy to find out the exact cause of the bone pain in the area. Excision biopsy can help in removal of the lesion as well as in detecting the cause of pain.
Till then taking mild pain killers will help her.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Excision biopsy and bone scan will help.
Detailed Answer:
Hello,
Thanks for posting your query.
The expansile lytic lesion in the 2nd and 3rd rib can be due to an infection or due to fibrous dysplasia or a malignancy. FNAC done was inconclusive. Since the treatment with AKT has not helped, now she can go for a bone scan or a bone biopsy to find out the exact cause of the bone pain in the area. Excision biopsy can help in removal of the lesion as well as in detecting the cause of pain.
Till then taking mild pain killers will help her.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Sir,
Thanks for responding. We are quite confused right now. We have got different opinions from different consultants. One of our consultant has said to go for excision biopsy while another Consultant suggested there is nothing to worry about and let it be as it is since the pain is not there right now.
Given the fact that this condition has been there for the last 12 years is there a cause for worry to think malignancy. If we do leave it as it is will it be a problem in future ?
Thanks for responding. We are quite confused right now. We have got different opinions from different consultants. One of our consultant has said to go for excision biopsy while another Consultant suggested there is nothing to worry about and let it be as it is since the pain is not there right now.
Given the fact that this condition has been there for the last 12 years is there a cause for worry to think malignancy. If we do leave it as it is will it be a problem in future ?
Brief Answer:
Excision biopsy is best option.
Detailed Answer:
Hello.
Thanks for writing again.
Since FNAC is inconclusive and the lesion is present for many years and it was painful till now it is best to get an excision biopsy done. The chances of malignancy are less but it is better to get the lesion removed as it will prevent the further growth and recurrent bone pain in future. Also, it will rule out malignancy for sure.
If it is left like this there are chances of the lesion getting bigger and then causing pain again.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Excision biopsy is best option.
Detailed Answer:
Hello.
Thanks for writing again.
Since FNAC is inconclusive and the lesion is present for many years and it was painful till now it is best to get an excision biopsy done. The chances of malignancy are less but it is better to get the lesion removed as it will prevent the further growth and recurrent bone pain in future. Also, it will rule out malignancy for sure.
If it is left like this there are chances of the lesion getting bigger and then causing pain again.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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