What is the diagnosis for diaphyseal (shaft of long bone) issues in a female?

From the Guidelines

In the case of a pregnant patient with suspected stress fracture of the long bones, radiographs should be the initial imaging evaluation because findings may be conclusive, and the benefit of diagnostic imaging far outweighs the risk. When considering the diagnosis of stress fractures in pregnant patients, it's crucial to weigh the risks and benefits of imaging modalities. According to the study by 1, the fetus' absorbed dose from radiography and CT will be substantially lower for long bones, and women can be reassured that the benefit far outweighs the risk with regard to diagnostic imaging.

Key Considerations

• Radiographs are recommended as the initial imaging evaluation for suspected stress fractures in long bones in pregnant patients.
• The predicted fetal absorbed dose from radiographs and CT scans not involving the abdomen or pelvis is less than 1 mGy, which is considered low risk.
• MRI does not use ionizing radiation and can be used as necessary to make the diagnosis if radiographs are inconclusive.
• The primary goal is to diagnose and manage the stress fracture effectively while minimizing risk to the fetus.

Imaging Modalities

• Radiographs: Initial imaging evaluation for suspected stress fractures in long bones.
• MRI: Can be used if radiographs are inconclusive or to provide further detail without exposing the fetus to ionizing radiation.
• CT scans: May be used in certain situations but are generally not the first choice due to radiation exposure, although the risk is considered low for long bones.

Clinical Decision Making

The decision to use imaging modalities in pregnant patients with suspected stress fractures of the long bones should be made on a case-by-case basis, considering the clinical presentation and the need for accurate diagnosis to guide treatment. The most recent and highest quality study, 1, supports the use of radiographs as the initial imaging evaluation, emphasizing the importance of balancing diagnostic needs with fetal safety.

From the Research

Diaphyseal Involvement in Ladies

• Diaphyseal involvement can be seen in various conditions, including osteomyelitis and multiple diaphyseal sclerosis (MDS) 2.
• Osteomyelitis is an inflammatory condition of bone secondary to an infectious process, and it can affect the diaphyseal region of long bones 3, 4, 5, 6.
• MDS, also known as Ribbing disease, is a rare congenital bone disease characterized by a fusiform widening of the diaphyseal portion of the long bones, caused by a thickening of the cortex with obstruction of the medullary cavity 2.
• Diagnosis of diaphyseal involvement can be challenging, and imaging modalities such as plain radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scans can be useful in identifying the condition 3, 2, 4, 5, 6.
• Laboratory evaluation and pathologic findings can also assist in excluding other diagnoses, but may be nonspecific 2.

Imaging Features

• Plain radiography can show a fusiform widening of the diaphyseal portion of the long bones in MDS 2.
• MRI can demonstrate areas of bone necrosis and marrow edema in osteomyelitis 3, 5.
• CT scans can provide detailed images of the bone structure and help identify any abnormalities 4.

Differential Diagnosis

• Osteomyelitis can be difficult to diagnose due to its similar radiographic appearance to other lesions, such as Paget disease or malignancy 4.
• MDS can be misdiagnosed as another type of sclerosing bone dysplasia, and differential diagnosis should be performed to exclude other conditions 2.