Radiopaque Lesion Research Articles

Ocular sarcoidosis: a case report

Introduction: Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. It is usually idiopathic. Ocular involvement is noted in 25%–60% of patients with systemic sarcoidosis. It is very essential to rule out ocular tuberculosis as both can have similar presentations. Case report: A 26 year old patient presented with blurring of vision in left eye for nine months at Mongar regional referral hospital. Previously he was treated with topical steroids and cycloplegics for anterior uveitis. There were no systemic symptoms like dry cough, fever, chest pain and loss of weight. He had anterior chamber inflammation with iris nodule, vitritis and disc edema in left eye.The right eye had minimal anterior chamber reaction with only subtle iris nodule. Posterior segment examination was normal in right eye. He underwent blood investigations, chest X ray and contrast enhanced computed tomography of chest(CECT). The blood reports were normal. The chest X ray showed radiopaque lesions at both hilar region and multiple tiny radiopaque lesions in both lung fields.CECT chest showed significant paratracheal lymph nodes.Lymph node biopsy was not attempted due to extreme location. Based on clinical presentations and investigation findings a diagnosis of Presumed ocular sarcoidosis was made by using the criteria based on Revised International Workshop on Ocular Sarcoidosis.The patient was treated effectively with oral steroids for six months. Currently he is on low maintenance dose of oral steroids. Conclusions: Ocular sarcoidosis is a potentially blinding condition if not treated on time. There should be high suspicion of ocular sarcoidosis if patient presents with bilateral granulomatous anterior uveitis with hilar lymphadenopathy.However it is crucial to exclude ocular tuberculosis as both are mimickers of chronic granulomatous uveitis.

Practical Approach to Radiopaque Jaw Lesions.

Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ©RSNA, 2021.

Composite odontoma with 23 denticles in a pediatric patient: A case report

Compound odontoma is an odontogenic tumor of ectomesenchymal origin containing tooth-like structures. Occasionally, this lesion may trigger occlusal, phonetic, and aesthetic disorders. The aim is to report a case of a compound odontoma containing 23 denticles in the anterior region of the maxilla of an infant patient. A 12-year-old male patient was referred for orthodontic treatment at Ribeirão Preto School of Dentistry, University of São Paulo (Ribeirão Preto, Brazil) complaining of a large diastema between the upper central incisors. Panoramic radiograph revealed the presence of a radiopaque lesion with tooth-like structures surrounded by a radiolucent rim in the anterior region of the maxilla, associated with distal displacement of the left central incisor. Surgical approach under general anesthesia revealed and extracted 23 denticles. Post-operative Cone beam computed tomography (CBCT) confirmed removal of all denticles, and further orthodontic treatment could be planned. Multidisciplinary involvement of pediatric dentist, oral and maxillofacial surgeon, and orthodontist was essential to achieve full functional, aesthetic, and psychosocial success.

Differential diagnosis between calcifying odontogenic cyst and adenomatoid odontogenic tumor by computed tomography images.

Calcifying odontogenic cysts (COC) and adenomatoid odontogenic tumors (AOT) have similar radiographic findings. We examined the radiographic and computed tomography (CT) images of patients histologically diagnosed with COC or AOT and identified their characteristic findings. The subjects included 12 patients histologically diagnosed with COC or AOT (one female and five males per group), who underwent CT at our hospital between Nov 1998 and Jun 2019. The location of the lesion, impacted tooth, bone expansion, root resorption, tooth migration, calcified body, and presence or absence of a high-intensity zone in the marginal area of the lesion were examined. In patients with COC, five patients with COC exhibited bone expansion toward the buccal side. The lesion encompassing the crown was attached to the cement-enamel junction and contained a radiopaque lesion with a calcified body. In 6 patients with COC, irregularly shaped calcified bodies were observed with small tooth-like structures. In patients with AOT, all six patients with AOT exhibited bone expansion toward the buccal and lingual sides. The lesion encompasses a part of the tooth root or the entire tooth. Punctate calcification was observed within the lesion and the marginal area in three patients, and a high-intensity zone was observed in the marginal area of the lesion in two patients. We report imaging findings that may be characteristic of COC and AOT, suggesting that CT findings may be useful for differentiating between COC and AOT.

Dense bone islands in pediatric patients: a case series study

BackgroundDense Bone Islands (DBIs) are anatomic variants defined as radiopaque lesions consisting of hamartomatous cortical bone, often presenting as incidental radiographic findings. DBIs can also be known as idiopathic osteosclerosis, bone whorl, focal periapical osteopetrosis, bone scar and enostosis. We found a paucity of literature for management and reporting of this condition in children. For this reason, the authors describe sixteen cases of children and adolescents with dense bony islands and suggest a pathway for management.Case seriesCases presented to the RNENT and Eastman Dental Hospital or private practice, either as chance findings or for diagnosis and treatment planning of undiagnosed radiopaque areas. The individuals were aged between 10 and 17 years; 6 boys and 10 girls. All radiographic reports described DBIs. Diagnoses were confirmed by a Dental and Maxillofacial Radiology Consultant and advised no intervention. In some cases, monitoring was advised. Caution in orthodontic tooth movement was advised for five patients.ConclusionDBIs are common findings that seldom require treatment; however, caution should be exercised when undertaking orthodontic movement in the area of a DBI due to a potential risk of root resorption. Accurate identification and multidisciplinary management are of utmost importance.

Dişsiz Hastaların Tam Protez ile Tedavisi Öncesi Alınan Panoramik Radyografilerin Klinik Öneminin Değerlendirilmesi: Bir Retrospektif Çalışma

Objective: The aim of this study was to assess the necessity of digital panoramic radiographs before patients' rehabilitation with removable complete denture and the rate of significant radiographic findings. Material and Methods: A total of 162 digital panoramic radiographs of edentulous patients were recorded over two years. The inclusion criteria were being edentulous and over 18- year old. The exclusion criterion was the insufficient quality of radiographs. All radiographs were analyzed by an oral and maxillofacial radiologist and a prosthodontist. Radiographic findings were classified as a radiopaque lesion, radiolucent lesion, mixed lesion, and extragnathic lesion. Radiographic findings were recorded and evaluate for requiring a pre-treatment before removable complete denture fabrication. The data were analyzed using SPSS v22.0 software (IBM Corp.). The level of significance was set at α=0.05. Descriptive data were calculated. Results: Panoramic radiographs of 86 (53%) female and 76 (47%) male were evaluated. 177 radiographic findings were identified at 107 (66%) panoramic radiographs. Radiopaque findings (46.5%) are the most frequent ones, among which root(s) or root fragment(s) (27%) are the most common. The percentage of radiographic findings which influence the treatment was 8.5%. Conclusion: Requesting routine panoramic radiography may not be provide great benefit to the patient. However, a detail anamnesis and examination should provide to decide the necessary of the panoramic radiography.

Dental and maxillomandibular incidental findings in panoramic radiography among individuals with mucopolysaccharidosis: a cross-sectional study.

Mucopolysaccharidosis (MPS) is a group of rare and inherited metabolic disorders caused by the accumulation of macromolecule glycosaminoglycans inside lysosomes. Affected individuals may have dental and craniofacial tissue alterations, facilitating the development of several oral diseases. Objectives To assess, with panoramic radiographic images, the frequency of dental and maxillomandibular incidental findings among MPS individuals and compare them with non-MPS individuals.Methodology A cross-sectional study evaluating a sample of 14 MPS individuals and 28 non-MPS individuals aged from 5 to 26 years was carried out. They were matched for sex and age on a 2:1 proportion. Panoramic radiographs were assessed for the presence/absence of the following dental and maxillomandibular alterations: dental anomalies of number (hypodontia/dental agenesis, supernumerary teeth); anomalies of form (microdontia, macrodontia, conoid teeth, taurodontism, and root dilaceration); anomalies of position (impacted tooth, inverted tooth, tooth migration, partially bony teeth, complete bony teeth); periapical alterations (furcation lesion, circumscribed bone rarefaction); other alterations (radiolucent bone lesions, radiopaque bone lesions, radiopacity in the maxillary sinus, condylar hypoplasia). Differences between groups were tested by the Fisher’s exact test and chi-square test (p<0.05).Results For intrarater agreement, Kappa values were 0.76 to 0.85. The presence of supernumerary teeth (p=0.003); conoid teeth (p=0.009); taurodontism (p<0.001); impacted teeth (p<0.001); partial bony teeth (p=0.040); complete bony teeth (p=0.013); and root dilaceration (p=0.047) were statistically more frequent in MPS individuals compared to non-MPS individuals. Bone rarefaction/furcation lesions (p=0.032), condylar hypoplasia (p<0.001), radiolucent bone lesions (p=0.001), and dentigerous cysts (p=0.002) were also more frequent in MPS individuals.Conclusion The presence of specific oral manifestations is more common in MPS individuals than non-MPS individuals.

Importance of preprosthetic routine panoramic radiography to detect asymptomatic pathologies in completely edentulous Libyan patients: A retrospective study

Background: Panoramic radiography (PR) is a diagnostic modality value for providing a view of the entire maxillofacial region in a single film with a relatively low dose of radiation. It is used as an initial screening tool to examine completely edentulous jaws for preprosthetic evaluation, to detect asymptomatic conditions as root fragments, impacted teeth, radiopaque or radiolucent lesions, and foreign bodies.Aim: The purpose of this study was to report the importance of PR survey of a partially and completely edentulous jaw, for detection of asymptomatic conditions prior to conventional or implant supported prosthetic rehabilitation.Material and Methods: The present study was conducted on 263 panoramic radiographs (PRs), collected retrospectively for Libyan completely edentulous patients. The sampled PRs were evaluated and the collected data were tabulated and analyzed using Microsoft Excel (Microsoft Office 2013). Results: The entire PR study subjects with pathological conditions were 73 cases (27.8%), while those with no pathologic conditions were 190 patients (72.2%). The most frequent pathological findings seen were residual cysts 33 (12.5%) followed by impacted third molars 16 (6.1%).Conclusion: The PR preprosthetic routine examination, is very useful and important diagnostic tool to detect asymptomatic conditions of the jaws and surrounding structures.

Cemento-Ossifying Fibroma of Maxilla: An Unusual Case Report

Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion which belongs to the same category of fibrous dysplasia and cement-ossifying dysplasia. It arises from the periodontal membrane which contains multipotent cells that are capable of forming cementum, lamellar bone, and fibrous tissue. It is more common in the mandible than in the maxilla. We present a case of COF in the maxilla, a rare occurrence in a 66-year-old female with the chief complaint of a swelling in the left upper back tooth region for the past 3 years. A panoramic radiograph was taken, which showed an oval radiopaque lesion in the second quadrant from 24 to maxillary tuberosity. In the maxilla, the clinical and radiological differential diagnosis includes fibrous dysplasia, giant cell lesions, cementoblastoma, calcifying epithelial odontogenic tumor, and peripheral giant cell granuloma. It is sharply circumscribed and demarcated from the surrounding bone, so surgical excision is the treatment of choice.

Imaging of Mixed and Radiopaque Jaw Lesions

Radiopaque lesions and lesions of mixed density are less frequent than radiolucent lesions of the jawbones. They comprise a spectrum of odontogenic and non-odontogenic lesions. The latter group includes inherited and developmental disorders, osteomyelitis, and benign and malignant primary bone tumors and metastases. Most odontogenic radiopaque or mixed lesions are either related to the apex or more rarely to the crown of the tooth, although there are exceptions to this rule. Some lesions, such as a torus mandibularis and torus palatinus, have a characteristic location, whereas others show no relationship to the dentition. This article describes the most characteristic and prevalent radiopaque and mixed lesions of the jaws and their imaging characteristics. Paget's disease, fibrous dysplasia, and rare sclerotic bone diseases of the maxillofacial bones are discussed elsewhere in this issue. Careful correlation of clinical presentation, panoramic radiographs, cone beam computed tomography, and histopathology are the cornerstones for appropriate lesion characterization.

IDENTIFICATION OF TONSILLITIS IN PANORAMIC RADIOGRAPHIES: LITERATURE REVIEW

This work aims to present a systematic review of the literature on the radiographic characteristics of these calcifications in soft tissues proper to the head and neck region. In view of the above, the use of panoramic radiographs is an important technique for the accurate diagnosis of tonsillitis. The work followed the exploratory study from the reading and selection of scientific articles in the databases LILACS and MEDLINE, published in the last 8 years, a record of the information extracted from the patients related to radiologic and pathologic evaluation of tonsillitis calcifications, and an analysis and interpretation of the results. Tonsillitis calcifications are caused by inflammation, the bacterial remnants feed on mucus that accumulate in the tonsillar crypts, thus serve as a site for the development of dystrophic calcification. Clinically they have a hardened consistency, rounded and without symptomatology. In larger calcifications pain, dysphagia, bad smell, swelling, and ulcerations can occur. They appear in conventional dental radiographs, presenting as multiple areas of poorly defined radiopacity; however, panoramic radiography is characterized as a radiopaque lesion, adjacent to or superimposed on the mandibular branch, like a dense bone island. It is concluded that knowledge of the radiographic anatomy is important to identify any patterns of abnormality. This work aims to present a systematic review of the literature on the radiographic characteristics of these calcifications in soft tissues proper to the head and neck region. In view of the above, the use of panoramic radiographs is an important technique for the accurate diagnosis of tonsillitis. The work followed the exploratory study from the reading and selection of scientific articles in the databases LILACS and MEDLINE, published in the last 8 years, a record of the information extracted from the patients related to radiologic and pathologic evaluation of tonsillitis calcifications, and an analysis and interpretation of the results. Tonsillitis calcifications are caused by inflammation, the bacterial remnants feed on mucus that accumulate in the tonsillar crypts, thus serve as a site for the development of dystrophic calcification. Clinically they have a hardened consistency, rounded and without symptomatology. In larger calcifications pain, dysphagia, bad smell, swelling, and ulcerations can occur. They appear in conventional dental radiographs, presenting as multiple areas of poorly defined radiopacity; however, panoramic radiography is characterized as a radiopaque lesion, adjacent to or superimposed on the mandibular branch, like a dense bone island. It is concluded that knowledge of the radiographic anatomy is important to identify any patterns of abnormality.

GARDNER SYNDROME PHENOTYPE WITHOUT GENE MUTATIONS

Gardner syndrome (GS) is a variant of familial adenomatous polyposis and is originally described by adenomatous polyposis of colon, osteomas in the skull and mandible, and epidermoid cysts. However, it may include soft tissue abnormalities, such as desmoid tumors, lipomas, and fibromas. We report a case of 61-year-old man complaining of poor oral condition, with a previous medical history of rectum adenocarcinoma (2013) and abdominal desmoid tumor (2017). During radiographic examination, multiple radiopaque lesions were observed in the body and ramus of mandible. Computed tomography of the mandible was requested, and a biopsy of 1 of the lesions was performed. Histopathologic examination was compatible with osteoma. He started genetic evaluation but APC and MUTYH genes were negative for pathogenic mutations. Although the genetics gave negative results, the clinical evaluation was very suggestive of GS. He maintained his condition in our service until he died.

SIALOLITH OF SUBMANDIBULAR GLAND: A CASE REPORT

The aim is to present a case of a patient with a history of volume increase in the left submandibular region and dysphagia. The palpation shows a hardened, mobile, and smooth surface volume increase. In computed tomography, in the coronal and axial sections we noticed a radiopaque lesion about 3.5 cm in diameter affecting the entire submandibular gland suggestive of giant sialolith. Removal was performed by means of the extramandibular submandibular approach of the sialolith and the submandibular gland. The patient is in postoperative follow-up of 3 years without motor or sensorial deficits and without relapses.

UNCOMMON ASSOCIATION BETWEEN HYAPERCEMENTOSIS AND PERIAPICAL LESION

This is a case of radicular cyst associated with tooth 22 of a 63-year-old woman, with complaint of increased gingival volume. The sensitivity test was negative and the periapical radiography showed a radiopaque lesion associated with the root of the tooth, circumscribed by a radiolucent lesion. An access and placement of paste of calcium hydroxide with olive oil was performed and a CT scan was requested. It wasn’t possible to remove the lesion that was associated with the root during the intraoperative period, choosing the tooth extraction, curettage of the lesion, a bone graft, and the placement of a membrane for posterior implant installation. The first microscopic exam revealed excessive formation of the cementum and the second shows cavity internally coated by epithelium and a fibrous connective tissue capsule that coats it externally, with chronic inflammatory infiltrate. The patient was diagnosed with hypercementosis and radicular cyst, respectively.

Resorption of entire impacted maxillary primary canine by permanent successor

A Japanese girl aged 4Y3M was referred for retarded eruption of the maxillary right primary canine. Radiographic examinations revealed the tooth to be impacted along with a tooth-like radiopaque lesion, which was extirpated under general anesthesia and histopathologically diagnosed as odontoma. At age 8Y3M, the position of the impacted primary canine was not changed, though the patient and guardians did not desire further treatment. Surprisingly, the crown as well as the root of the impacted primary canine appeared to be resorbed by its permanent successor after four years.

A case of low-grade central osteosarcoma of the mandible

Low-grade central osteosarcoma, a rare subtype of osteosarcoma, is less aggressive than conventional osteosarcoma. We report ac case of low-grade central osteosarcoma of the mandible. A 52-year-old woman presented to our department for treatment of a swelling in the right side of the mandible. Computed tomography revealed ground glass radiopaque lesions associated with an expansive growth pattern in the mandibular bone. Because a suspicion of low-grade central osteosarcoma was diagnosed In the biopsy sample provided from the previous hospital, the lesion was surgically resected. Histopathologically, the tumor consisted of a dense proliferation of spindle cells with mild atypia. At the periphery of the lesion, the normal cortical bone was invaded by tumor nests. Low-grade central osteosarcoma was diagnosed in the surgical specimen. Tumor recurrence has not been observed for more than 6 years after surgery. Low-grade central osteosarcoma is hard to differentiate from osteogenic benign neoplasm or bone malformation. Therefore, when radiographic findings reveal an expansive ground glass appearance, a bone biopsy including the normal cortical bone and the central part of the lesion is essential.

An Unexpected Smile

Question: A 79-year-old man with a history of diabetes and dyslipidemia experienced painful swelling in the left knee after falling onto the ground. He noticed that his dentures were missing after the fall; however, he could not recall whether he swallowed the dentures. Consequently, he was sent to the emergency department and diagnosed with a quadriceps tendon rupture and periosteal sleeve avulsion fracture of the left patella. A lateral view of the neck did not reveal any radiopaque lesion, and the prevertebral soft tissue thickness remained normal (Figure A).

Gambaran sementoblastoma tahap awal pada cone beam computed tomography (CBCT) 3D

Objectives: The purpose of this study was to report a case of mandibular cementoblastoma with radiologic approach and describe its characteristics.&#x0D; Case Report: A 32-year-old female came to the Hospital and complained of swelling of the left side of the lower jaw. Clinical examination showed a strong swelling in the buccal region of teeth 44-45, with the same soft tissue color as the surrounding tissue. In the picture cone beam computed tomography appears as a rounded lesion, the internal structure of the radiointermediet with clear and firm boundaries, surrounded by a halo radiolucent. Cementoblastoma radiodiagnosis is established. The patient was referred for surgery.&#x0D; Conclusion: Cementoblastoma was a benign tumor with radiographic characteristics in the form of clearly demarcated radiopaque lesion with radiolucent halo. Some early-stage lesions can show lower density.

Prevalence of dental anomalies and bone alterations in children’s panoramic radiographies

ABSTRACT Objective To verify the prevalence of dental anomalies in terms of number, position and shape, and the presence of bone alterations, through analysis of panoramic radiographs. Methods This study evaluated dental anomalies and bone alterations in children aged 6 to 12 years-old, detected on panoramic radiographies recorded in the radiographic database of the Federal University of Espírito Santo between 2012 and 2016. Clinical and demographic information were registered. Dental records were retrieved to obtain the medical history involving syndromes or other diseases that may interfere with the anomalies and alterations. Chi-square and exact Fischer’s statistical tests were performed. Results There were alterations in 83 out of 301 panoramic radiographs analyzed. There were 169 anomalies or alterations (mean of 2,04±1,38 anomalies/patient), involving 201 teeth. The most prevalent anomaly was tooth impaction (26.63%), which affected the canines more frequently, followed by hypodontia (24.26%), more often found in the second premolar, and both affected mostly females. Hyperdontia and radiolucent lesions showed the same prevalence (18.93%), the most affected teeth were those of the anterosuperior region and the first mandibular molars, respectively. The least prevalent anomalies were dilaceration (7.69%), taurodontism (2.37%) and radiopaque lesions (1.18%). Bone alterations were significantly more found in mandible and in the posterior region, which confirms the prevalence in the lower molars. Conclusion Although there was no statistically significant difference regarding sex, there was a high prevalence of anomalies and alterations in our study population, which indicates the importance of its diagnosis by means of a panoramic x-ray examination.

Desmoplastic ameloblastoma of the mandible: A rare case report

Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma that shows unique features, behavior, and presentation. This article reports a rare case of desmoplastic ameloblastoma in a 67-year-old male patient, who presented with a slow-growing, asymptomatic lesion in the anterior mandible which was observed over a period of 4 years. Radiographic findings revealed an ill-defined mixed radiolucent and radiopaque lesion with displacement of adjacent teeth. Histopathological examination showed proliferation of odontogenic cells in the form of islands separated by dense, fibrous connective tissue stroma compressing the islands. Although the incidence of this variant is very low, a differential diagnosis of the same must be taken into consideration when locally aggressive, chronic swellings of jaw are encountered in routine practice to aid in early diagnosis and in initiating a prompt management.