57-Year-Old Man With Multiple Sources of Pain

March 19, 2014
Series editor: Eric Bogner MD

The man, who is on dialysis, presented with pain in numerous joints at once. The images don't show signs of arthritis. Can you guess the diagnosis from descriptions of the findings?

A 57-year-old man, who is on hemodialysis, presented with complaints of pain in his shoulder, wrist, and hip.

Radiographs demonstrated marked soft tissue swelling of the right shoulder and a relative preservation of the glenohumeral joint.  (Note the renal dialysis catheter.) 

 

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The right wrist demonstrates marked atherosclerotic disease with suggestion of multiple radiolucencies or “holes in the bones,” most notably in the scaphoid

 

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The MRI demonstrates multiple cyst-like foci about the left hip, with preservation of the left hip joint.

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There is also massive thickening of the bilateral hamstring origins

 

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 Diagnosis: Amyloidosis    

Amyloidosis can occur as a primary, idiopathic process but is more commonly seen in the setting of renal pathology or multiple myeloma.

There are multiple types of amyloid that can be deposited about the musculoskeletal system. Deposition is typically in the periarticular soft tissue, within tendons or ligaments, or within the bones about a joint.  Deposition of the ossesous structures is seen as nonspecific radiolucencies which can appear as soft tissue or cyst like lesions on cross sectional imaging.

There is classically a relative preservation of the joint space which on occasion may be narrowed from a long standing process or secondary processes such as osteoenecrosis with secondary arthrosis.

Disclosures:

Adapted from the teaching files of the Department of Radiology and Imaging at Hospital for Special Surgery. Series editor: Eric Bogner MD, Associate Attending Radiologist. - See more at: http://www.rheumatologynetwork.com/myositis/myositis-ossificans#sthash.WqfrLVwm.dpuf

References:

Resnick. Bone and Joint Disorders. 3rd edition. Vol. 3. 2002

Kurer MH, Baillod MD, and JC Madgwick. Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years. Journal of Bone and Joint Surgery - British Volume, Vol 73-B:271-276.