posttraumatische zystische Knochenläsion

Fett im
Frakturkallus bei distaler Radiusfraktur. Ca. 2 Monate nach der ursprünglichen Fraktur fanden sich in dem Bereich der Periostreaktion regionale, scharf begrenzte Lysezonen. Die zu diesem Zeitpunkt angefertigte MRT zeigte in der periostalen Knochenneubildung an dieser Stelle fetthaltiges Material. Dies ist als seltene, transiente Erscheinung im Rahmen der Frakturheilung (insbesondere bei Kindern und insbesondere am distalen Radius) zu sehen. Röntgenbilder vom Unfalldatum, nach 2 Monaten, nach ca. 1,5 Jahren. MRT T1cor, T2m STIR, T1 FS ax, T1 FS sag.
Wikipedia • CC BY-SA 4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. Dorsovolar (3a) and lateral (3b) radiographs. The oval-shaped lucency on the dorsal aspect of the distal radius, is now more demarcated with partially a sclerotic margin.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. Dorsovolar (3a) and lateral (3b) radiographs. The oval-shaped lucency on the dorsal aspect of the distal radius, is now more demarcated with partially a sclerotic margin.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. There is complete consolidation of the fracture. The lucency on the dorsal side of the distal radius is still sharply demarcated with partially a sclerotic margin, but now with mild diaphyseal migration of the lesion.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. There is complete consolidation of the fracture. The lucency on the dorsal side of the distal radius is still sharply demarcated with partially a sclerotic margin, but now with mild diaphyseal migration of the lesion.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. An axial (5a) and a coronal (5b) T1-weighted image. These images demonstrate a small well-defined subperiosteal and intracortical lesion, with a high signal intensity.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. An axial (5a) and a coronal (5b) T1-weighted image. These images demonstrate a small well-defined subperiosteal and intracortical lesion, with a high signal intensity.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. Sagittal T2–weighted fat-suppressed image (5c) showing the subperiosteal localisation of the lesion, with high signal intensity of the lesion indicating the absence of fat and suggestive of blood.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. Close-up of the dynamic axial image. Red arrow pointing at the minimal rim enhancement.
www.eurorad.org • CC by-nc-sa-4.0
Benign
post-traumatic cortical cyst-like lesion following a distal radial fracture in a child. Static coronal T1-weighted fat-suppressed image after contrast administration (5f). Enhancement is difficult to evaluate, due to the high signal intensity on all previous sequences.
www.eurorad.org • CC by-nc-sa-4.0
Post-traumatic
cystic lesion following radius fracture: a case report and literature review: A, B. X-ray performed four months later from a new trauma
www.ncbi.nlm.nih.gov • CC by 4.0
Post-traumatic
cystic lesion following radius fracture: a case report and literature review: A, B. MRI of the cystic lesion
www.ncbi.nlm.nih.gov • CC by 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Post-traumatic cystic bone lesions, also known as fracture cysts, are benign, transient post-fracture cysts, which are relatively uncommon and usually appear about one-to-two months after traumatic fracture.

Epidemiology

They are rare but may be under recognized, as monitoring after fracture often is only clinically. They have most often been reported in children of growing age. The most common reported site is the distal radius .

Clinical presentation

Though mostly asymptomatic in nature, patients with these transient lesions can present with moderate soft swelling .

Pathology

Characteristics of these lesions are:

  • non-expansile cyst of <1 cm in diameter
  • may be multiple
  • close proximity to former fracture site

Typically encountered at about a month after initial fracture, they have been reported to occur as late as 18 months after the initial trauma .

Etiology

There is ongoing debate whether these transient lesions represent intramedullary fat inclusions cysts (most accepted theory) or resorption cysts of excessive periosteal reaction caused by subperiosteal hematoma or intraosseous hemorrhage .

Radiographic appearance

Plain radiograph

Typical appearances are that of a subcentimeter oval or round lucency without expansivity, peripheral condensation or periosteal reaction and close proximity to the site of former fracture.

Treatment and prognosis

As all hitherto reported lesions resolved spontaneously, no treatment is needed.

Differential diagnosis

Encountering a cyst-like lesion close to a healing fracture (probably even greenstick fracture) can make the diagnosis straightforward. More challenging diagnostic scenarios, however, can comprise lack of former studies (or unawareness of their existence, unavailability at other institutions, etc), incomplete clinical information or a long period between initial fracture and lesion on actual imaging studies.

In those cases and in general differential diagnostic considerations may include:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu posttraumatische zystische Knochenläsion:
benigne
Osteolysen
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Fett in
Frakturkallus
Wikipedia • CC BY-SA 4.0