Question:

Which of the following statements are true concerning intraosseous pneumatocyst?
1. Treatment with curettage and bone graft.
2. These lesions showed post contrast enhancement.
3. These lesions typically are well defined with thin sclerotic margin.
4. These lesions are surrounded by bone marrow edema.
5. The adjacent joint may or may not show degenerative changes.





Answer:

The correct answers for the question "Which of the following statements are true concerning intraosseous pneumatocyst?" are:

3. These lesions typically are well defined with thin sclerotic margin.

5. The adjacent joint may or may not show degenerative changes.



Explanation
1- These lesions are benign no intervention is necessary. [The awareness of the benignity of these incidental lesions and their different appearances in all modalities are of extreme importance, as they do not require follow up, biopsy or surgical intervention.]

2- These lesions don`t show post contrast enhancement. [Normal signal intensity of adjacent bone and with no contrast enhancement.]

3- These lesions are well defined with thin sclerotic margin best seen on CT scan. [CT scan is the diagnostic modality of choice for these lesions because it can depict the content of these lesions precisely, can assess if the density is consistent with gas. It can also identify small lesions and determine gas-density or the gas-density-fluid level. CT scan clearly identifies the sclerotic thin border of these lesions and the presence or absence of surrounding bone or soft tissue abnormalities.]

4- Normal bone marrow signal should surround these lesions. [Normal signal intensity of adjacent bone and with no contrast enhancement.]

5- Degenerative joint or disc disease is seen adjacent to pneumatocyst in adults however some pneumatocyst seen near a completely normal joint especially in children. [These lesions have been described in some literature as part of degenerative disease based on the fact of their proximity to a joint that shows degenerative changes, other reports have documented the presence of connection between these cysts and joint space, which explains the reason that these lesions may in fact be caused by vacuum phenomenon. However, other lesions have been reported in areas away from a joint or near completely normal joints without evidence of degenerative changes or without a clear connection to the joint space as it was in our case.]



From the manuscript:
Incidental Intraosseous Pneumatocyst with gas-density-fluid level in an adolescent: a case report and review of the literature
Radiology Case. 2014 Mar; 8(3):16-22


This article belongs to the MSK section.




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From the manuscript

Incidental Intraosseous Pneumatocyst with gas-density-fluid level in an adolescent: a case report and review of the literature

Free full text article: Incidental Intraosseous Pneumatocyst  with gas-density-fluid level in an adolescent:  a case report and review of the literature

Abstract
Intraosseous pneumatocyst is a gas containing lesion located within a bone. It is a relatively rare condition of unclear etiology and with an undetermined natural course. Gas-density-fluid level pneumatocyst is even rarer. Pneumatocyst is frequently seen in adults but rarely reported in pediatrics. The lesion is usually small and is seen in the vertebral bodies as well as around the sacroiliac joints. Rarely does it occur in other parts of the skeleton. We are reporting a case of large blood signal intensity containing intraosseous pneumatocyst in a 14 year old boy and reviewing other pediatric cases of pneumatocysts as well as those with gas-density-fluid level. The recognition of this incidental rare benign lesion is essential to avoid over investigation and an inappropriate aggressive intervention.






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