OSSEOUS PATHOLOGY DIAGNOSED ON ULTRASOUND
John Ferrier, York and Scarborough Hospitals NHS Foundation Trust
Introduction and Objectives:
Musculoskeletal Ultrasound (MSK US) has become a fundamental tool in diagnostic radiology, with increasing utilisation for evaluating joint and soft tissue conditions. Its advantages include a detailed, real-time, and dynamic soft tissue assessment. This is delivered in a cost-effective manner (1). Due to the limitations of ultrasound, traditionally, bone evaluation has relied on radiographs, CT, and MRI. However, ultrasound can effectively assess the bone surface thanks to its tomographic capabilities and high resolution (2). Despite limited literature on ultrasound-detected bone pathology, our institution has identified a diverse range of osseous lesions during MSK US examinations, primarily when assessing for presumed soft tissue pathologies.
Description:
We present a case series illustrating various osseous pathologies identified on ultrasound, including fractures from trauma and inflicted injury; sequelae of infection such as osteomyelitis and Brodie’s abscess; avascular necrosis; benign lesions such as osteochondromas and osteoid osteoma and malignant bone lesions including osteosarcoma, chondrosarcoma and bone metastases. Sonographic features are demonstrated alongside corroborative imaging and management strategies.
Results:
This case series emphasises the importance of routinely evaluating the underlying bone during MSK ultrasound assessments of presumed soft tissue lesions. Familiarity with normal and abnormal sonographic bone appearances is critical to avoid missing significant osseous pathology. We aim to encourage practitioners to consider bone pathology in their differential diagnoses when assessing presumed soft tissue masses.
Conclusion:
MSK ultrasound, while traditionally focused on soft tissue, offers valuable insights into underlying bone pathology. Incorporating systematic bone assessment into routine ultrasound examinations enhances diagnostic accuracy and can facilitate earlier detection and management of a wide array of osseous lesions. An understanding of sonographic appearances of bone pathologies can help guide further imaging and management.
References:
1. SoR/BMUS Guidelines for Professional Ultrasound Practice. Revision 6, December 2021.
2. Bianchi S. Ultrasound and bone: a pictorial review. J Ultrasound. 2020 Sep;23(3):227-257.