Abstract No. 456 - Image-guided percutaneous treatment of aneurysmal bone cyst of the jaw with bone allograft and autologous bone marrow: a case report with five-year follow-up

Abstract

No. 456 Image-guided percutaneous treatment of aneurysmal bone cyst of the jaw with bone allograft and autologous bone marrow: a case report with five-year follow-up R. Freitas, K. Fonseca, R. Procopio, L. Lehman; Radiology, Universidade de Sao Paulo Medical School, Sao Paulo, Brazil; Oncology pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Interventional Radiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Buco-maxillo Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Purpose: A six-year old boy with an aneurysmal bone cyst of the jaw was treated by percutaneous injection of bone allograft particles mixed with autogenous bone marrow under computed tomography (CT) guidance and general anesthesia. Materials and Methods: A six-year old boy presented with a mass at the left angle of mandible, self-limited recurrent oral bleeding, pallor and severe pain partially controlled with opioids. Open surgical biopsy revealed a fibrous bone lesion with giant cells. A thin-walled 7 x 6 x 6 cm diameter (132 cc) expansible bone lesion at the left angle of mandible containing fluid-fluid levels was detected by X-ray plain film, CT scan, ultrasound, and magnetic resonance imaging. A diagnosis of an aneurysmal bone cyst was stated. A minimally invasive percutaneous approach was proposed after multidisciplinary review and an informed consent was obtained. Frozen dried bone allograft particles obtained from tissue bank were crushed, mixed with fresh autogenous bone marrow and injected into the lesion by a percutenous 11-gauge needle under CT and fluoroscopy guidance. No complications were observed. Results: The patient was discharged from the hospital the next day without symptoms. After two weeks he returned at consultation without bleeding or pain complaints. Normal serum hemoglobin was observed three months later. CT scans performed during five years of follow up showed progressive healing, ossification of the left branch of the jaw, tumor shrinking and remodeling. No pain or bleeding was reported since the percutaneous treatment. Conclusion: This case report shows excellent healing of a locally aggressive aneurysmal bone cyst after image-guided percutaneous injection of autogenous bone marrow mixed with elements of allograft bone matrix. Five years of follow-up showed excellent functional and cosmetic results. Further research is required to clarify the exact mechanisms of this potential treatment. Educational Exhibit Abstract No. 457 Ultrasound guided percutaneous tenotomy/ fasciotomy: indications, technique, and initial experience A.S. Johar, M.C. Switzer, A. Braun; Radiology, Maricopa Medical Center, Phoenix, AZ Learning Objectives: The objective of this poster is to 1) Discuss the pathophysiology of tendinosis and the common clinical presentations. 2) Review the US findings of chronic tendinopathy. 3) Describe the percutaneous tenotomy technique and its advantages over traditional tendinopathy treatments. 4) Outline our initial experience with outpatient ultrasound tenotomy. Background: Tendinopathy is a common and underdiagnosed pathology which often impairs daily and recreational activities. Given its debilitating nature, a range of treatment options exist, many of which are conservative and few of which provide durable complete symptom relief. Ultrasound guided percutaneous tenotomy is a relatively new and promising technique with the ability to remove pain causing diseased tendon tissue without damaging the adjacent healthy tendon tissue. This technique is gaining traction due to its minimally invasive nature, quick recovery time, low cost, low morbidity and durable positive outcomes. Clinical Findings/Procedure Details: We will demonstrate the findings of tendinopathy by presenting supporting US images from multiple cases. We will detail the percutaneous ultrasonic tendon cutting and debriding technique while describing pertinent pearls and pitfalls. Finally, we will discuss the outcomes from our cases. Conclusion and/or Teaching Points: After reviewing the poster, viewers will be familiar with the pathology, presentation and imaging findings of chronic tendinopathy. Viewers should appreciate US guided percutaneous tenotomy as a minimally invasive, fast and effective treatment option for tendinopathy pain. Educational Exhibit Abstract No. 458 Lymphangiography: not gone, not forgotten E. Lindgren, J. Friese, C.E. Bender; Radiology, Mayo Clinic, Rochester, MN JVIR ’ Posters and Exhibits S199