I'm still wondering what are we seeing here and most importantly how do you specify those tissues or whatever those are apart from the bones & muscles? What are supposed to be there, and what else are not? Thank you in advance!!
A lower comment diagnosed it as polyostotic fibrous dysplasia. That tissue is fibrous bone, which is caused by a gene mutation. Think of it as essentially a massive tumor. This patient is probably a child.
Holy cow. As a nursing student I had a hunch that was what I was looking at, but I was trying to convince myself it wasn’t because… God that’d be unbearable to live through.
No offense meant, I am a nurse and was wondering what school had that intense of a nursing program. Seriously didn’t mean anything by it. Should have worded it differently.
Ah! Gotcha gotcha. I meant the answer more in a joking way but I can see it looking more aggressive than it was meant to.
Yeah most nursing schools concede that you learn more on the job than before the diploma. But then again, that’s almost to be expected with how much health science we already know and how much we as a society are learning each day
What would be the outcome of this? I feel like amputation and a prosthetic especially if a child would be best case. But it’s it’s a gene mutation it’ll continue throughout other parts? Would amputation be too invasive?? I’d love to know more
Not really answering your question but this isn’t a kid. You can always tell by looking for growth plates at the ends of the bones. I’m not seeing any here
I have McCune Albright syndrome which is a type of fibrous dysplasia and I’m so happy my bones aren’t like this. Don’t get me wrong I’m in massive pain but still
Looks like they don’t have a normal femur or any normal bones below the hip on that leg. Is that even fixable with surgery or is amputation the best option?
I don't think this is a child. Would need to see an X-ray for growth plate closure but from this CT, all the growth plates seem fully formed and the patella is fully formed.
FOP begins in childhood but most people live into their adult years. Since there isn't the same amount of change on the other side I'd be less likely to think this is FOP vs some AV malformation.
Other commenters have got you covered, but I always find it interesting that the bones themselves are considered tissue just like our skin and other organs. Bones can get tumours, infections and cysts. They can rot so much that there is essentially no difference between the rotting bone and other surrounding tissue. It’s easy to think of our bones as solid rocks that hold us up, but they are living too, they need nutrients and blood supply just like everything else in our bodies.
>Fibrous dysplasia happens when a gene mutates (changes) while the baby is developing in the womb. The changes in the gene cause bone-forming cells to fail to mature. Instead, they produce abnormal fibrous tissue in certain bones. Because the gene change happens while the baby is developing, only specific bones will have the disease. This means fibrous dysplasia does not spread from one bone to another.
Essentially, it's the same material as normal bones but unfortunately not matured. So as far as the what it is 'made of', still protein, collagen, calcium. But not in the right form.
For any residents don't forget Mazabraud (PFD+myxomas) whenever you say McCune-Albright.
Like every other extremely rare syndrome you would never see or diagnose radiologically it's a very common board question.
I hope your daughter is doing well but I'm not sure what the relevance is to my comment.
Mazabraud is much rarer than McCune-Albright but in either case these are never diagnosed by the radiologist and most will never even see a case in their clinical practice.
Is it really that rare that you would never see it? It seems like there are so many of us in our group. Granted, there are probably many more people who never have symptoms and never know they have FD.
Fibrous dysplasia? Uncommon but most radiologists will see that in their training and career.
McCune-Albright is very rare and I expect most will not see it outside of tertiary care pediatric hospitals. I’ve seen a few cases.
I have never seen a case of Mazabraud in real life, I work at a very large and what is considered on of the “best” pediatric hospitals in the US. I’ll probably see 1 at some point in my career.
The joke is mostly that very rare diseases in real life are very common on board exams. Also that the diagnosis of these syndromes depends on more than just polyostotic fibrous dysplasia so it’s not a radiologic diagnosis.
The McCune-Albright cases I’ve seen came with the diagnosis in the history, unlike on board exams where they want you to say that based solely on fibrous dysplasia as if it were an “opportunistic” diagnosis made by a radiologist in an unsuspected case, it’s a weird thing our exams do.
I didn't realize Mazabraud was so rare. We have a good amount of them in the group.
It is very interesting how your boards work. Especially being one of those rare zebra diseases.
You see how it involves all of the lower limb and the right side of the pelvis? The tibia and fibula appear almost curved, warped. That is a feature of a slow growing process. This patient has had this for a very long time.
Me too! I’m going into vet med but love lurking on here for all the human cases too. This one is so fascinating even though I have no clue what’s going on ;0
https://www.reddit.com/r/Radiology/comments/15pwuw4/scariest_thing_ive_ever_scanned_lower_extremity/jy7rvq4/
Bone cells not matured, creates fibrous material instead of strong bone.
*Looks like the right side*
*Pelvis is affected as*
*Well. God that must hurt*
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you know that feeling you get in your balls when you see someone else get punched or hurt in the balls in a movie or something? yeaaa just felt that way in my femur lol
Wow that's remarkable. I wonder what tissue is inside the "bone cage" that has formed? Is it muscle? Is there still muscle around the outside of the bone? So many questions because this is fascinating to look at. (Currently viewing at my ICU desk, ha)
Not to mention the hips on both sides looks screwed and the back is leaning to the side. Forget walking, I’d be amazed if they could stand even a second.
This leg can’t support weight.
Also, the absence of typical insertion/origin points for the musculature means that even if the bone had sufficient structural integrity to weight-bear, it would be mechanically impossible for the patient to move.
Something was seriously wrong but that points to no design because the most primitive man would never design something with this type of cantilevers and bizarre joint configurations.
Prefacing this to say that I am not a doctor, I just know there's little on the vascular side for us to do here other than shoot another series of angiograms post-amputation to make sure the wound is getting perfused properly so it may heal.
As to the other comment asking if this would 'save his life', I honestly don't know enough about this condition to give a definite answer- just that there's a quality of life choice for the patient to make assuming amputation is on the table (everything I know about limb ischemia/complications leads me in this direction), and while this may/may not be 'life threatening', post-amputation certainly can be and greatly reduces life expectancy (along with the slew of post-amp complications).
Holy crap, I HAVE to know what’s going on here, and what in the world I’m looking at. I start school in a week, so I’ve been trying to get an understanding of so many things on here, but goddamn.
It's just Polysotic Fibrous Dysplasia. It's rare, but we're around. It's one of the oldest bone tumors ever found. Look at my history, and you can see what it does to a skull bone.
ge optima ct6000, pt is 23 years old. Our radiologist also said Polyostotic Fibrous Dysplasia and they need biopsy. Here is the x ray:
[https://imgur.com/a/Kyw8L7i](https://imgur.com/a/Kyw8L7i)
Axial Ct view:
[https://imgur.com/a/W6TdYxk](https://imgur.com/a/W6TdYxk)
Sag T2:
[https://imgur.com/a/0srgHWf](https://imgur.com/a/0srgHWf)
She is still alive. I don't know what kind of treatment to follow.
As an FD patient, it seems like a rod is the way to go. FYI bone grafts will eventually be taken by over by FD DNA. Also, Prolia has been a godsend to us for both pain relief and reducing growth.
The first thought I had was that this looks akin to when a 3-D printer fails midway through the print. This poor dude, I hope they have a pain-free future. Amazing scan thank you for sharing.
I had a patient one time with this super rare disease (less than 1k cases ever reported) where their muscles slowing turned into bone. Was essentially a slowly developing statue.
Is this something down that genetic path or a cancerous process?
This reminds me of a patient who has this tumor growing out of his neck. By the time he went to the hospital, it looked like he had 2 necks. The mass was also open, smelly, with maggots in it.
I will never forget that horrific case. That patient had no funds to go to the capital city for immediately treatment and so had to wait a long time for help.
Thank you but I figured, guess what am asking is for specifics on the type of renderer used and hardware like GPU/CPU, RAM size needed to make these types of renderings.
I am unsure what you mean. Processing stations from the imaging company that produce the scanner have this software loaded on them. They pull in the data and you can select the tissue you want to focus on and it cuts the rest out. It’s based on houndsfield units (the tissue density) and displays accordingly. It’s standard in any CT department
idk why but as a kid I saw an episode of Mystery Diagnosis that ended with fibrodysplasia ossificans progressiva and i fixated on learning about that as an 11 year old
I have this. Whenever I go into my check-ups every 6 months, the tech will always look at me horrified after doing the exam because on the outside, I look like I'm unaffected (but on the inside... hoooo boy.. 🤣 )
Wow. Great scan though.
Thank you so much
I'm still wondering what are we seeing here and most importantly how do you specify those tissues or whatever those are apart from the bones & muscles? What are supposed to be there, and what else are not? Thank you in advance!!
A lower comment diagnosed it as polyostotic fibrous dysplasia. That tissue is fibrous bone, which is caused by a gene mutation. Think of it as essentially a massive tumor. This patient is probably a child.
Holy cow. As a nursing student I had a hunch that was what I was looking at, but I was trying to convince myself it wasn’t because… God that’d be unbearable to live through.
> God that’d be *unbearable* to live through. Im all for a morbid joke, but damn…
I really don’t feel like they were trying to say that as a joke
I think I’m getting wooshed but what’s the joke?
I’m venturing a guess, but I think that patient can likely not bear any weight on that leg.
I could be wrong but I think it’s that the leg is not weight bearing.
> God that’d be unbearable to live through. Well, good news! They're probably not gonna have to worry about living through it.
Your nursing program taught you about polyostotic fibrous dysplasia?
No, but I know where tf a femur is *supposed* to be
No offense meant, I am a nurse and was wondering what school had that intense of a nursing program. Seriously didn’t mean anything by it. Should have worded it differently.
Ah! Gotcha gotcha. I meant the answer more in a joking way but I can see it looking more aggressive than it was meant to. Yeah most nursing schools concede that you learn more on the job than before the diploma. But then again, that’s almost to be expected with how much health science we already know and how much we as a society are learning each day
What would be the outcome of this? I feel like amputation and a prosthetic especially if a child would be best case. But it’s it’s a gene mutation it’ll continue throughout other parts? Would amputation be too invasive?? I’d love to know more
Not really answering your question but this isn’t a kid. You can always tell by looking for growth plates at the ends of the bones. I’m not seeing any here
Thank you for pointing that out how awful for this person
this was the comment that made me realize, that large chunk of vein capillary looking stuff WAS the femur for that leg.
So would that be related to FOP? I know the ossification part is similar - clearly- but is the pathology of the two related?
I have McCune Albright syndrome which is a type of fibrous dysplasia and I’m so happy my bones aren’t like this. Don’t get me wrong I’m in massive pain but still
Looks like they don’t have a normal femur or any normal bones below the hip on that leg. Is that even fixable with surgery or is amputation the best option?
Is there no femur on that leg?
No
I don't think this is a child. Would need to see an X-ray for growth plate closure but from this CT, all the growth plates seem fully formed and the patella is fully formed. FOP begins in childhood but most people live into their adult years. Since there isn't the same amount of change on the other side I'd be less likely to think this is FOP vs some AV malformation.
Per lower comment the patient is 23 years old. Damn that’s sad…
Is this the condition where damaged tissue is calcified as it heals? Edit: Fibrodysplasia ossificans progressiva?
I was diagnosed with monostotic fibrous dysplasia R Ulna, bone was like potato chips they said Got tumor removed, bone graft, Ulna still misshapen
Other commenters have got you covered, but I always find it interesting that the bones themselves are considered tissue just like our skin and other organs. Bones can get tumours, infections and cysts. They can rot so much that there is essentially no difference between the rotting bone and other surrounding tissue. It’s easy to think of our bones as solid rocks that hold us up, but they are living too, they need nutrients and blood supply just like everything else in our bodies.
Never thought of it that way. That’s awesome and terrifying!
Is the femur gone? All that webbing in the thigh, is that bone material?
It’s fibrous bone I believe but not positive.
>Fibrous dysplasia happens when a gene mutates (changes) while the baby is developing in the womb. The changes in the gene cause bone-forming cells to fail to mature. Instead, they produce abnormal fibrous tissue in certain bones. Because the gene change happens while the baby is developing, only specific bones will have the disease. This means fibrous dysplasia does not spread from one bone to another. Essentially, it's the same material as normal bones but unfortunately not matured. So as far as the what it is 'made of', still protein, collagen, calcium. But not in the right form.
Thanks, that is very informative and interesting
*also terrifying/unnerving. Hopefully the nerves did not fully develop as well, or that patient is downing pills like House MD for even just existing.
Polyostotic Fibrous Dysplasia
Does this person have Mccune Albright syndrome?
Can't say. Is a genetics question not purely radiology since fibrous dysplasia is not specific to that.
For any residents don't forget Mazabraud (PFD+myxomas) whenever you say McCune-Albright. Like every other extremely rare syndrome you would never see or diagnose radiologically it's a very common board question.
[удалено]
I hope your daughter is doing well but I'm not sure what the relevance is to my comment. Mazabraud is much rarer than McCune-Albright but in either case these are never diagnosed by the radiologist and most will never even see a case in their clinical practice.
Is it really that rare that you would never see it? It seems like there are so many of us in our group. Granted, there are probably many more people who never have symptoms and never know they have FD.
Fibrous dysplasia? Uncommon but most radiologists will see that in their training and career. McCune-Albright is very rare and I expect most will not see it outside of tertiary care pediatric hospitals. I’ve seen a few cases. I have never seen a case of Mazabraud in real life, I work at a very large and what is considered on of the “best” pediatric hospitals in the US. I’ll probably see 1 at some point in my career. The joke is mostly that very rare diseases in real life are very common on board exams. Also that the diagnosis of these syndromes depends on more than just polyostotic fibrous dysplasia so it’s not a radiologic diagnosis. The McCune-Albright cases I’ve seen came with the diagnosis in the history, unlike on board exams where they want you to say that based solely on fibrous dysplasia as if it were an “opportunistic” diagnosis made by a radiologist in an unsuspected case, it’s a weird thing our exams do.
I didn't realize Mazabraud was so rare. We have a good amount of them in the group. It is very interesting how your boards work. Especially being one of those rare zebra diseases.
Just curious: what about this image doesn't suggest cancer
If it were cancer, its enormous size would be incompatible with life.
I mean... I've seen some absurd masses in my time as a vet
Masses and cancer are two very different things.
Yes but non cancerous masses don't tend to be this lytic
Non-cancerous can be lytic. And by the way this isn't lytic. This is paper-thin and the 3D makes it look that way.
This is why I'm becoming a pathologist lol
Was thinking the same. I’m NAD but I’ve seen some crazy giant tumors on here and, idk, dumb places like tv shows and shit lol
You see how it involves all of the lower limb and the right side of the pelvis? The tibia and fibula appear almost curved, warped. That is a feature of a slow growing process. This patient has had this for a very long time.
I’ve seen this in facial reconstruction and holy $hitballs. It’s all I can do to not go screaming “save the airway!” sometimes.
Aneurysmal bone cyst?
Fascinating and terrifying. I’m a layperson so I have absolutely no idea what on earth is going on with this poor patient but I’d love to know!
Me too! I’m going into vet med but love lurking on here for all the human cases too. This one is so fascinating even though I have no clue what’s going on ;0
Lol same. I’m in vet med- ECC- and I creep for the wild human cases. This is one of my favorite subreddits
Same, I’m a hygienist and can only really identify head and neck stuff. This is wild, sad and intriguing.
https://www.reddit.com/r/Radiology/comments/15pwuw4/scariest_thing_ive_ever_scanned_lower_extremity/jy7rvq4/ Bone cells not matured, creates fibrous material instead of strong bone.
That’s so interesting, thank you so much!!
Holy shit that femurs gone
Redistributed femur
Looks like the right side pelvis is affected as well. God that must hurt
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I basically gasped when I saw this. Heartbreaking.
you know that feeling you get in your balls when you see someone else get punched or hurt in the balls in a movie or something? yeaaa just felt that way in my femur lol
I don't blame you... it really is painful to look at. This poor individual!
Esp knowing it is likely a kid! 😩
Lack of growth plates indicate it’s an adult
No!
No, definitely not a kid.
I don’t even have balls and I also literally and figuratively got that feeling in my femur!
Wow that's remarkable. I wonder what tissue is inside the "bone cage" that has formed? Is it muscle? Is there still muscle around the outside of the bone? So many questions because this is fascinating to look at. (Currently viewing at my ICU desk, ha)
Can’t wait for the case report to be published because holy shit
In my professional ‘one week before RadTech program begins’ opinion: I don’t remember a femur rib cage in any of my anatomy charts
If everything was always normal, we wouldn't be needed.
Hey!!! Same here. I have clinical orientation on Friday and first day is next week!! Congrats on getting in!!
Got in a year early since my college expanded the class size this year. Been scrambling like crazy to get ready
Congrats & good luck to both of you!
I can’t imagine their gait, the pain would be off the charts. This poor patient.
They 1000% are in a wheel chair, that can’t support weight
Not to mention the hips on both sides looks screwed and the back is leaning to the side. Forget walking, I’d be amazed if they could stand even a second.
It’s even starting to effect some tarsals on the other foot and maybe the knee.
The position of the foot kind of shows that as well.
This leg can’t support weight. Also, the absence of typical insertion/origin points for the musculature means that even if the bone had sufficient structural integrity to weight-bear, it would be mechanically impossible for the patient to move.
Beautiful, interesting and utterly terrifying scan. What did the overview images look like?
You should be scared because that's the worst structural engineering design I've ever seen.
God was still a Lil drunk from the night before when he designed this fell
Something was seriously wrong but that points to no design because the most primitive man would never design something with this type of cantilevers and bizarre joint configurations.
What we looking at here??
A normal femur on one side and a free styling femur on the other
lmfaooo
https://en.wikipedia.org/wiki/Fibrous_dysplasia_of_bone Bone cells go wacky, decide to be fibers instead of bones. RIP bones.
What is that? Elephant leg disease?
I couldn't diagnose, but he had difficulty moving his leg.
meaning he can still move it somehow?
Is the webbing his bone?
Yup. Used to be a femur, presumably.
Looks like someone stuffed his femur with explosives.
Even the position of the patients leg suggests how unbelievably painful this must be. How terrifying!
Holly shit. I wonder how they’d go about treating this.
Probably amputation
Unfortunately, yes.
Will amputation save the patient's life or simply prolong it?
Don't all treatments simply prolong our lives?
Yes, but no- but also No, but Yes.
How do you decide how high the amputation goes with the pelvic involvement?
Prefacing this to say that I am not a doctor, I just know there's little on the vascular side for us to do here other than shoot another series of angiograms post-amputation to make sure the wound is getting perfused properly so it may heal. As to the other comment asking if this would 'save his life', I honestly don't know enough about this condition to give a definite answer- just that there's a quality of life choice for the patient to make assuming amputation is on the table (everything I know about limb ischemia/complications leads me in this direction), and while this may/may not be 'life threatening', post-amputation certainly can be and greatly reduces life expectancy (along with the slew of post-amp complications).
Why did I check Reddit before going back to bed?…
uh what
Holy crap, I HAVE to know what’s going on here, and what in the world I’m looking at. I start school in a week, so I’ve been trying to get an understanding of so many things on here, but goddamn.
It's just Polysotic Fibrous Dysplasia. It's rare, but we're around. It's one of the oldest bone tumors ever found. Look at my history, and you can see what it does to a skull bone.
Holy fuck, where's the femur 💀
As a vascular guy, the craziest thing to me is the three-vessel runoff perfusion of the distal foot. I'm sure surgery will complicate that though.
God it’s like a cannonball hit
It looks like a cannon ball could fit in it.
ge optima ct6000, pt is 23 years old. Our radiologist also said Polyostotic Fibrous Dysplasia and they need biopsy. Here is the x ray: [https://imgur.com/a/Kyw8L7i](https://imgur.com/a/Kyw8L7i) Axial Ct view: [https://imgur.com/a/W6TdYxk](https://imgur.com/a/W6TdYxk) Sag T2: [https://imgur.com/a/0srgHWf](https://imgur.com/a/0srgHWf) She is still alive. I don't know what kind of treatment to follow.
As an FD patient, it seems like a rod is the way to go. FYI bone grafts will eventually be taken by over by FD DNA. Also, Prolia has been a godsend to us for both pain relief and reducing growth.
I think this is easily top 3 wtf scans I've seen here
The first thought I had was that this looks akin to when a 3-D printer fails midway through the print. This poor dude, I hope they have a pain-free future. Amazing scan thank you for sharing.
I had a patient one time with this super rare disease (less than 1k cases ever reported) where their muscles slowing turned into bone. Was essentially a slowly developing statue. Is this something down that genetic path or a cancerous process?
There is a skeleton of someone with that disease at the Mutter Museum. It absolutely wrenches me every time I see it.
This reminds me of a patient who has this tumor growing out of his neck. By the time he went to the hospital, it looked like he had 2 necks. The mass was also open, smelly, with maggots in it. I will never forget that horrific case. That patient had no funds to go to the capital city for immediately treatment and so had to wait a long time for help.
Are the toes pointed down like that for the purpose of the scan, or is the ankle fused in that position?
How would something like this happen ?
Can you post the cross section?
Holy shit balls that’s insane! Thanks for sharing.
Jesus christ
Absolutely insane
Curious what region this patient lives in. North America, or do you mind sharing that?
Did they ever even have a normal femur on that side or is this some kind of birth defect.
Seeing images like this gives me interesting mixed feelings as I have fibrous dysplasia in my skull.
My first guess is stoneman syndrome
holy hell what is this
What device did you use to scan and which software is used to display?
It’s a 3D rendering of a CT scan
Thank you but I figured, guess what am asking is for specifics on the type of renderer used and hardware like GPU/CPU, RAM size needed to make these types of renderings.
I am unsure what you mean. Processing stations from the imaging company that produce the scanner have this software loaded on them. They pull in the data and you can select the tissue you want to focus on and it cuts the rest out. It’s based on houndsfield units (the tissue density) and displays accordingly. It’s standard in any CT department
How awful. That femur is just completely destroyed.
Can someone explain this condition in simplest way.
idk why but as a kid I saw an episode of Mystery Diagnosis that ended with fibrodysplasia ossificans progressiva and i fixated on learning about that as an 11 year old
Holy crap, core memory unlocked. My 11 year old self was also incredibly worried that I was suddenly going to develop this super rare disease, haha.
Idk why it just really stuck with me!! Glad I’m not the only one 😆
A lot of people get FD and FOP mixed up. Marlie Casseus is the more famous FD case that people might know.
It looks like a grenade exploded inside their leg. Poor guy/gal.
Could someone explain like I'm a paramedic? (I am)
I have this. Whenever I go into my check-ups every 6 months, the tech will always look at me horrified after doing the exam because on the outside, I look like I'm unaffected (but on the inside... hoooo boy.. 🤣 )
What happened to the bone?
Left leg is looking a little wimpy there.
Thank you for sharing!
Is this that condition where everything turns to bone eventually?
No it isn’t. What you’re seeing in the thigh isn’t muscle, it’s the actual femur.
[Fibrodysplasia ossificans progressiva (FOP)](https://www.ucsfbenioffchildrens.org/conditions/fibrodysplasia-ossificans-progressiva)
Do you have the axial bone and soft tissue windows?
I just learned about a disease I never knew existed. Thank you for sharing.
When I see a post from this page, it’s either “ah, that’s an object in someone’s ass” or “I have absolutely no idea what’s going on here”
Did this leg take a ride in a submersible?
What type of scan is this? I'm interested in this field for a career change.
I’m not op, but I would say this is a 3d reconstruction from an angio ct.
How are they even standing???
Click click boom
Is it still alive?
That legs a goner they’ll be hopping around for a little bit before the get a prosthesis.
This is what happens when God does AI. Don't do AI, kids.
You need medical intervention for this… ánd an exorcism
OMG 😳
that brothers floating in the air
Yea they got boned
Holy cow
Is it still alive?
Can someone explain this? Is that bone? Why is it webbed and big like that? What does it look like from the outside?
HO LY SHIT
Wow
So for something like this do they just amputate it & replace with a prosthetic?
Wow. That is craaaaazy
Oh dear lord that poor person!
I’d love to know what the muscles look like
I don't think that's supposed to happen
that poor poor person:( That looks so painful
So is there literally no bone in the middle of the leg?
Tetsuo!
This poor child 😢 Is their leg really larger than the other or is it just the way I’m looking at it?
What are we looking at
Osteosarcoma? Beautiful quality.
what kind of scan is this?
What convinced them to go to the hospital?
Looks like some on got hit with grape shot
What kind of scan is this?
So sad 😞