Thread by @tatcantarelli

7yo girl
Chronic wrist pain
X-ray = not available
Previous trauma = not clear

???

#MSKrad #radiology #orthotwitter #PedRad #radiologia

What do you think?

Since the're over 100 votes in the poll, I'll give the answer. Looking at the MRI, there's a diffuse edema of the scaphoid: trauma? , avascular necrosis? (Preiser) /3 #MSKrad

But there's also a lytic lesion in the proximal pole, with perilesional bone marrow edema, soft tissue edema, periostitis and focal synovitis. Ddx: OO?, Infection? (Brodie's abscess), malignancy? /4 #MSKrad

The girl also complained of pain in her right ankle.
MRI findings: osteolytic lesions extending through the physis in the distal tibia and fibula, with bone marrow edema, soft tissue edema, periostitis and synovitis /5 #MSKrad

The final diagnosis was CRMO (chronic recurrent multifocal osteomyelitis) or CNO (chronic non-bacterial osteomyelitis). Usually a diagnosis of exclusion and always a challenge. #MSKrad

CRMO is an idiopathic inflammatory bone disorder. It can take months to years to diagnose. CRMO/CNO lies along the same clinical spectrum of SAPHO syndrome /7 #MSKrad

A companion case:
12yo boy. Bilateral chronic ankle pain
MRI findings: bilateral osteolytic lesions extending through the physis in the distal tibia and fibula, and also talus, with bone marrow edema, soft tissue edema, periostitis and synovitis /8 #MSKrad