Radio-opaque Lesions Research Articles

Xanthogranulomatous Osteomyelitis: Two Rare Cases Report

INTRODUCTION: Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory lesion that is histologically characterized by the presence of foamy histiocytes and plasma cells (1-8). Radiologic and gross examinations can mimic malignancy (9), so carful workup and definitive diagnosis should be made by histopathologic evaluation. Case Report: There are two rare cases being reported here; the first one is a 21-year-old male who presented with chronic pain and swelling of upper leg for one year. He has history of healed traumatic fracture of fibula 7 years ago. Radiological examination revealed highly suspicious radio opaque lesions of upper fibula. The second case is a 30 years old female, presented with pain and swelling of wrist for six months with clinical suspicion of Ewing sarcoma. Radiological examination revealed highly suspicious radio opaque, lytic lesions of lower radius. Biopsy of both lesions were done. Microscopic examination showed marked chronic inflammatory cells infiltration mainly foamy histiocytes and lymphoid cells with many foreign body giant cells. No evidence of tuberculosis or malignancy. Conclusion: As these lesions were clinically highly suspicious of malignancy or associated with other diseases, so proper diagnostic roles in xanthogranulomatous osteomyelitis should include histopathological examination in order to rule out any malignant conditions of the bone.

Idiopathic Mandibular Osteosclerosis: A Case of Complex Diagnosis

The purpose of this study is to report a case of idiopathic osteosclerosis of the mandible and to discuss the differential diagnosis of this lesion. A 17-year-old female was referred to the University Hospital of Geneva by her orthodontist following the fortuitous finding of a radio-opaque lesion in the right posterior mandible at the apex of tooth 44. Intraoral clinical examination revealed no abnormalities of the oral mucosa. Tooth 44 was asymptomatic and reacted positively to the sensitivity test. The orthopantomogram revealed a well-defined unilocular radiodense lesion, surrounded by a thin radiolucent border, measuring 10 × 33 mm, located in the IV quadrant, related to the apex of tooth 44. Differential diagnoses mainly included cementoblastoma, focal cemento-osseous dysplasia, ossifying fibroma, condensing osteitis and idiopathic osteosclerosis. The biopsy material allowed a diagnosis of idiopathic osteosclerosis. The proposed treatment was therefore a “wait and see” approach. After 2 years of follow-up, the patient was asymptomatic, and healing was complete without any neurosensory complications. Our case underlines the differential diagnosis complexity of radio-opaque lesions associated with teeth.

A case report on “ODONTOMA” a riddle from time to time

Odontomas are relatively asymptomatic odontogenic hamartomatous malformations, commonly in association with impacted or retained primary teeth. They appear as small, solitary or multi-layered radio-opaque lesions which often interfere with tooth eruption. These are diagnosed during routine dental examinations. This case report describes the case of a compound odontoma in a 10-year-old girl associated with an impacted permanent left maxillary incisor. A surgical excision was performed and a histopathological examination revealed a compound odontoma.

Solitary Radio-Opaque Lesion of Wrist (Tumoral Calcinosis) Disappears Spontaneously After Causing Acute Carpal Tunnel Syndrome: A Case Report.

We describe the case of a 53-year-old male patient with a history of acute carpal tunnel syndrome (CTS) provoked by a radio-opaque mass on the palmar side of the wrist. Although the mass disappeared in new radiographs 6 weeks later without any intervention apart from the carpal tunnel release, excisional biopsy was conducted on the residue, revealing tumoral calcinosis. Both acute CTS and spontaneous resolution are clinical manifestations of this rare condition on suspicion of which biopsy can be avoided by following a "wait and see" strategy.

A rare case report of focal cement osseous dysplasia associated with recurrent periodontal abscess

Focal cemento-osseous dysplasia (FocCOD) is a fibro-osseous lesion of the jaw, which is usually asymptomatic. We report the case of FocCOD in association with recurrent periodontal abscess. A 58-year-old female reported a chief complaint of swelling of gums for 2 months. Periodontal abscess with respect to 35 and 36 tooth regions was noted with no associated tooth mobility. Panoramic view showed extensive generalized horizontal bone loss suggestive of generalized chronic periodontitis. There was a characteristic radio-opaque lesion in relation to apices of 34 and 35. The periodontal abscess was recurrently formed even after repeated scaling, curettage, and antibiotic coverage. The associated teeth were extracted along with the hard tissue mass, and the histopathological examination of the latter revealed FocCOD. This case report intends to highlight the diagnostic dilemma and management of a rare, symptomatic FocCOD associated with recurrent periodontal abscess.

Florid osseous dysplasia, lesi radiopak bilateral pada radiograf panoramik

Objectives: The aim of this report is to present a case of florid osseous dysplasia and understand its characteristics from panoramic radiography.
 Case Report: A 47-years-old female patient came to the oral and maxillofacial radiology department at Dental and Oral Hospital of Universitas Padjadjaran to take panoramic radiography. Patient’s chief complaints were pain on tooth 46 after being extracted about 4 days ago with numbness on the extraction area. Panoramic radiograph showed radioopaque lesions in the extraction area surrounded by a thin radiolucent area. In the periapical region of tooth 36 and 47 showed the same radiopaque image as tooth 46. The radiodiagnostic suspect of the lesions was bilateral florid osseous dysplasia in the posterior region of the mandible.
 Conclusion: The images of florid osseous dysplasia from panoramic radiography are radioopaque, well-defined, sclerotic border, and having soft tissue capsule when the lesion is immature condition. The most common condition of FOD affect both upper and lower jaw, but if the lesion only occur in one jaw, the lesion commonly happen in mandible with exact location is more posterior than canine teeth.

Abdominal distention

A 41-year-old man with a history of congenital mental retardation was admitted because of newly diagnosed diabetes mellitus with hyperosmolar hyperglycemic state. A kidney ureter bladder radiograph for abdominal distention demonstrated a radio-opaque lesion (Figure 1A, arrow) superimposed over the right psoas muscle. Coronal reformatted computed tomography image of the contrast-enhanced abdominal scan showed an irregular high-density mass inside the third portion of the duodenum (Figure 1B, white arrow), with a radiolucent lesion extending from the bulb to the second portion of the duodenum (Figure 1B, black arrow). Esophagogastroduodenoscopy demonstrated a toothbrush in the bulb, with the toothbrush head in third portion of duodenum. The toothbrush was removed by the following endoscopic procedure of three steps. First, we pulled the distal end of toothbrush into the stomach by a snare (Cook Medical, Bloomington, IN). Second, the toothbrush head was pulled into the stomach by a foreign body retriever (Olympus FG-44NR-1, Tokyo, Japan). Third, the toothbrush (19 cm in length) was pulled out from stomach by a snare smoothly (Figure 2). The differential diagnosis of a radio-opaque lesion of abdomen may include: calcified bezoar, artificial teeth, soft tissue mass with calcification, or a radiolucent foreign body with a metallic part. A characteristic radiographic image of a toothbrush showed parallel rows of short metallic radiodensities due to the metallic plates with the bristles. Foreign bodies longer than 10 cm cannot pass through the duodenal C-loop due to its fixed retroperitoneal position.1 These objects should be removed by endoscopy as soon as possible to prevent pressure necrosis and perforation of the gastrointestinal tract.2 Laparoscopic gastrotomy should be performed if endoscopic removal fails.

Compound Odontoma in Maxillary Anterior Region Involving Central Incisor: A Case Report

Odontomas are hamartomatous developmental malformations of dental tissues. They are benign odontogenic tumors appearing as small, solitary or multiple radio-opaque lesions on radiographic examinations. The majority of odontomas are asymptomatic and discovered incidentally commonly odontoma occurs as compound and complex types. These lesions, sometimes can cause potential disturbances in the eruption of neighboring teeth, such as delayed eruption, impaction, or even retention of deciduous dentition, henceforth; conservative surgical excision is the treatment of choice. This case report presents a compound odontoma in 10 year old girl along with its related clinical and radiological manifestations and the surgical management.

Ameloblastomatous Calcifying Odontogenic Cyst: A Rare Lesion

Introduction: Calcifying odontogenic cyst (COC) is a unique and uncommon odontogenic cyst classified into four groups of cystic, odontoma producing, ameloblastomatous proliferating and neoplastic ones. Case Presentation: A 34-year-old Iranian man complaining of a painless facial and palatal swelling of the left side of the maxilla persisted for approximately three years was referred to the department of oral and maxillofacial surgery, Hamadan University, Iran. Panoramic film revealed a well-defined multilocular mixed radiolucent and radioopaque lesion of the maxilla at the left side. An incisional biopsy was obtained. Based on the histopathologic findings, ameloblastomatous COC was diagnosed. Discussion: We reported a rare case of COC. According to Praetorius et al. classification, this patient comes under the category of type 1C (ameloblastomatous proliferating). Many patients with ameloblastomatous COC should be reported to understand its biological behavior as possible.

Post-traumatic Ossification of the Distal Radioulnar Joint

A 41-year-old lady had a history of fall injury with her left hand landed outstretched. The initial radiographs showed no fracture. She complained of persistent wrist pain and stiffness. The subsequent follow-up radiographs showed progressive radio-opaque lesion over the volar aspect of the distal radio-ulnar joint. Surgical excision was performed and patient regained full wrist joint motion and grip power.

"Compound composite odontoma associated with un-erupted permanent canine": A case report

Odontomas are benign odontogenic tumors appearing as small, solitary or multiple radio-opaque lesions on radiographic examinations. Among the two types of odontomas, compound odontomas are painless, with a more limited growth potential than complex odontomas. The majority of odontomas are asymptomatic and discovered incidentally; however, may be accompanied with pain and swelling as secondary complaints in some cases. These lesions, at times, may cause potential disturbances in the eruption of neighboring teeth, such as impaction, delayed eruption or retention of deciduous dentition, henceforth, conservative surgical excision is the treatment of choice. Here, a case of compound composite odontoma is reported, discussing the related clinical and radiological manifestations, the surgical approach performed, and histopathological features.

A Case Report of Compound Odontoma Associated with an Unerupted Maxillary Central Incisor

Odontomas generally appear as small, solitary or multiple radio-opaque lesions found on routine radiographic examinations. Traditionally, odontomas are the most common type of odontogenic tumor and they are generally asymptomatic. Occasionally, odontomas may cause disturbances in the eruption of teeth, such as impaction, delay eruption or retention of primary teeth. In general, odontomas occur more often in the permanent dentition. This is a case report of a compound composite odontoma in an 8-year-old boy, which has resulted in failure of eruption of the permanent upper right central incisor while the contra-lateral tooth had erupted.

The effect of poloxamer 407-based hydrogel on the osteoinductivity of demineralized bone matrix.

BackgroundDemineralized bone matrix (DBM) is used for bone healing due to its osteoinductivity, but it requires a carrier for clinical application. Here, we report the effects on the osteoinductivity of DBM by use of a poloxamer 407-based hydrogel as the carrier, compared to sterile water.MethodsDBM-W and DBM-H represent 27 wt% of DBM with sterile water and DBM with a poloxamer 407-based hydrogel, respectively. Both of the compositions were applied to human mesenchymal stem cell (MSC) cultures, and monitored for alkaline phosphatase (ALP) staining and ALP activity. Six 10-week-old athymic nude rats were used for abdominal muscle grafting with either DBM-W or DBM-H, and were tested by plane radiography, microfocus X-ray computed tomography (CT), and decalcified histology to evaluate ectopic bone formation.ResultsThe DBM-W group showed stronger ALP staining at 7, 14, and 21 days of treatment, and significantly higher ALP activity at 7 and 14 days of treatment, compared to the DBM-H group. Plane radiography could not confirm the radio-opaque lesions in the rat ectopic bone formulation model. However, ectopic bone formation was observed in both groups by micro-CT. Compared to the DBM-H group, the DBM-W group showed higher bone volume, percent bone volume and trabecular number, and the difference in percent bone volume was statistically significant. Decalcified histology found bony tissue with lamellation in both groups.ConclusionsOur results suggest that poloxamer 407-based hydrogel has efficacy as a DBM carrier since it shows ectopic bone formation, but its effects on the quality and quantity of osteoblastic differentiation in rat abdominal ectopic bone and MSC are considered negative.

Compound Odontomas in Saudi Child : A Case Report

Odontomas are odontogenic lesions with occurrence rate of 22% in the oral Cavity. They generally appear as small, solitary or multiple radio-opaque lesions on routine radiographic examinations and are subdivided into complex or compound odontomas morphologicaly. Compound odontomas occur commonly in the incisor-canine region of the maxilla and complex odontomas are located frequently in the premolar and molar region of both jaws. This paper describes a case of compound odontoma in anterior maxilla blocking the eruption of upper incisors and canine in a eight years old child. The surgical excision of the lesion was performed to allow the eruption of permanent teeth. In present case three years follow up indicate no sign of recurrence. Early detection of odontomas allows the adoption of a less complex expensive treatment, eruption of permanent teeth and ensures better prognosis.

Recurrent osteoblastoma of the maxilla

Osteoblastoma is a benign neoplasm which commonly occurs in the vertebral column and long bones. The tumour grows slowly and rarely recurs after surgery. This report presents the clinicopathological and radiological findings of a case of recurrent osteoblastoma in the maxilla. A 7-year-old male patient visited our department with chief complaints of left facial swelling and pain. A panoramic radiograph showed a homogeneous radio-opaque expansile lesion in the left maxilla. The lesion was thought to be fibrous dysplasia and the patient underwent a surgical excision using the Caldwell-Luc procedure. Histopathological examination of the lesion confirmed it as benign osteoblastoma. The lesion recurred 6 months after the initial surgery. CT images revealed a large mass with multiple internal calcifications. Subsequently, the patient underwent mass excision with subtotal left maxillectomy. Follow-up CT scans at 1 year intervals showed no recurrence for 5 years.

Loculated hydrothorax: An unusual complication of hepatic cirrhosis

A 67-year-old man with hepatic cirrhosis caused by alcoholism and with no cardiopulmonary history was admitted for symptoms of hepatic encephalopathy secondary to constipation. The chest X-ray showed a radio-opaque lesion, rounded with regular edges in the left hemithorax that was not present in previous check-ups (Fig. 1). Empirical antibiotic treatment was started due to suspected pneumonia. In the thorax CT, the collection showed smooth, regular edges and content with “water” density, suggesting the possibility of loculated intrathoracic ascites (Fig. 2). The patient’s symptoms rapidly improved, but the above lesion persisted on discharge, disappearing after a month of diuretic therapy (Fig. 3). Loculated hydrothorax: An unusual complication of hepatic cirrhosis

Brown tumors in dialyzed patients with secondary hyperparathyroidism: Report of 16 cases

Brown tumors (BTs) are relatively uncommon but they are serious complications of renal osteodystrophy. The objective of this study was to analyze the clinical, biological, and radiological characteristics of 16 patients with BTs provoked by secondary hyperparathyroidism (sHPT) and its response to the decrease in parathyroid hormone levels after parathyroidectomy (PTX). The management of that uncommon condition was also reviewed. We conducted a retrospective study including 16 end-stage renal disease patients who underwent subtotal PTX between 1997 and 2007 for severe sHPT with BTs. Our study included 10 men and 6 women, whose average age was 34 years. All patients were on dialysis. Ten of them were on dialysis for more than 5 years. The median duration on dialysis was 84 months. Patients included suffered from swellings associated with functional limitations. BTs had multiple locations in 7 patients. Jaw was the most frequent location (62%). Radiography and tomodensitometry demonstrated a mixed radio lucent and radio-opaque lesions with an expansion of the cortical bone. Bone scan demonstrated an increased uptake of lesions. Chirurgical treatment was indicated in all cases because of severe refractory sHPT with functional limitations and/or disfiguring deformities. In all cases, BTs stopped its progression and even decreased in size. However, it was insufficient in four cases, which required a surgical resection. PTX remains an efficacious approach in resistant cases of sHPT with persistent BTs.

치아종에 의한 유치의 매복: 증례 보고

치아종은 유치나 영구치배의 지속적인 치배 형성이나 법랑기 세포들의 비정상적인 증식의 결과로 발생하는 방사선 불투과성 병소로, 비교적 흔한 치원성 종양이며 인접한 치아의 맹출을 방해 할 수 있다. 치아종은 영구치열기에서 주로 관찰되고, 유치열기에서는 매우 드문 것으로 보고되고 있다. 본 증례 보고에서는 치아종에 의해 매복된 유치가 치아종의 외과적 발거 후 자연 맹출된 증례들을 보고하고자 한다. 매복유치는 계승 영구치의 발육과 맹출 문제를 야기할 수 있기 때문에 치아종이 제거된 후에도 계승 영구치가 맹출할 때까지 장기적인 검사 및 관찰이 필요하다. Odontomas generally appear as small, solitary, or multiple radio-opaque lesions found on routine radiographic examinations. It is a comparatively common odontogenic tumor, and may lead to interfere with the eruption of its associated tooth. In general, odontomas occur more often in permanent dentition and are very rarely associated with primary teeth. This report deals with five rare cases of primary teeth impaction associated with odontomas, with spontaneous eruption occurring in all five cases after simple surgical removal of the odontoma. Impacted primary teeth may be associated with defects in development and eruption of their permanent successors, and thus long-term observation is necessary until the permanent successors erupt.

Bilateral adenomatoid odontogenic tumour of the maxilla in a 2-year-old female—the report of a rare case and review of the literature

Multifocal odontogenic lesions are uncommon and have only been observed in conditions associated with known genetic mutations. To the best of our knowledge, only two cases of multifocal adenomatoid odontogenic tumours (AOT) have previously been reported in the literature. In this study, we report the first case of a bilateral, separate AOT in the maxilla in the midline in a 2-year-old female. The patient presented with bilateral expansile masses in the maxilla on either side of the midline which had been present for 6 months. She was asymptomatic and had occasional difficulty in breathing. The tumour was diagnosed as AOT and was surgically enucleated along with the associated teeth. The patient recovered well and has been on recall for 5 years. The follow-up panoramic radiograph made a fortnight ago revealed evidence of three new radio-opaque lesions with an associated tooth in the region of the anterior mandible, the premolar region of the right maxilla and the molar region of the left maxilla. To acquire additional information about AOT, all reports regarding AOT cited in 'PubMed' from 1995 onward were reviewed and the incidence, clinical features, radiographic features and management of AOT are discussed in this study.

Soft Tissue Squamous Cell Carcinoma in Chest Wall with an Incomplete Border Sign

Squamous cell carcinoma (SCC) of the soft tissue in chest wall from an unknown primary site is extremely rare. We report a case with soft tissue metastasis with histology of SCC to chest wall with an incomplete border sign in chest radiography. Chest radiography revealed a radio-opaque lesion in the left lung field. Computed tomography (CT) detected the mass under the musculus pectoralis major invading the left 2nd - 6th ribs with increase in pleural thickness. Careful radiological observations, including chest radiography and CT, may aid the diagnosis and planning of treatments. doi:10.4021/jmc115w