Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis (p. 63). Before you turn to the discussion, examine these images carefully and draw your own conclusions. History For the discussion, click here. A 55-year-old man on…
Diagnostic Imaging in Patient with Left Hip Pain: Findings
View the question. Findings/Diagnosis The AP radiograph of the left hip (see Figure 1) shows periarticular, well-defined erosions of the left hip (white arrow) without joint space narrowing or osteophytes. There is no fracture. There are surgical clips and a calcified mass in the right hemipelvis (black ellipsis), representing a failed renal transplant. The coronal STIR…
Intensive Program Relieves Symptoms of Juvenile Fibromyalgia
Pain can be reduced and functionality significantly improved for children with fibromyalgia without drug therapy, according to a study of 64 children in Philadelphia. Researchers combined intensive physical therapy and psychotherapy in individualized programs to treat the fibromyalgia patients…
Polymyalgia Rheumatica Misdiagnosis Results in Positive Outcome
In late February 2011, a 68-year-old woman visited the rheumatology outpatient clinic. She had been congenitally healthy and had been a field athlete in her early days. Beginning in early January 2011, she became aware of pain in her neck and both shoulders, with pain spreading to her lower back and thighs. She also became…
Diagnostic Imaging in Patient with Atraumatic Left Shoulder Pain: History
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History A 56-year-old man with end-stage renal disease on peritoneal dialysis presents…
Diagnostic Imaging in Patient with Atraumatic Left Shoulder Pain: Findings
View the question. Findings/Diagnosis The AP radiograph of the left shoulder (see Figure 1) shows erosions of the proximal humeral and glenoid articular surfaces (black arrows) without joint-space narrowing. There is a well-defined marginal erosion with overhanging edge at the junction of the proximal humeral articular surface and rotator cuff insertion on the greater tuberosity (ellipse)….
Ultrasound-Defined Tenosynovitis Beats Signs, Symptoms for Spotting Early RA
NEW YORK (Reuters Health)—Ultrasound-defined tenosynovitis (TS) is a strong predictor of early rheumatoid arthritis (RA), according to new findings presented at the European League Against Rheumatism (EULAR) Annual Congress in Rome. Patients with TS of the extensor carpi ulnaris (ECU) tendons or the finger flexor tendons were more than six times as likely to be…
Diagnostic Imaging in Patient with Soft Tissue Calcification: Findings
View the question. Findings/Diagnosis The radiographs demonstrate diffuse sheetlike and tumefactive calcifications throughout the subcutaneous tissues, muscle and fascia of the pelvis and right hand. The underlying bones and joint spaces appear normal. The differential diagnosis for soft tissue calcification is extensive and includes metabolic disturbances (particularly of calcium and phosphate), trauma (e.g., injection sites,…
Diagnostic Imaging in Patient with Soft Tissue Calcification: History
Editor’s note: In this recurring feature, we first present a series of images (this page) for your review, and then a brief discussion of the findings and diagnosis. Before you turn to the discussion, examine these images carefully and draw your own conclusions. History These radiographic images are of a 25-year-old woman with a known…
Rheumatology Coding Corner Question: Trigger-Point Injections for Fibromyalgia
A 65-year-old established female patient returns to the office for a follow-up visit for her diagnosis of fibromyalgia. She complains of pain, stiffness and swelling in her left hand, elbow and neck that is persistent since her last visit. The pain is considerably worse in the morning. She denies any fevers, cough or dyspnea. The…
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