a case report on myositis ossificans progressiva


a case report by Dr VAMSHI under guidance of DR GVS MURTHY

what is ur diagnosis and plan of management

what is the cause for this condition and your plan of management?

a 14 yr old boy came with chief complaints of deformity of rt forearm
h/o trauma 6 years ago..was hit by teacher at school
later he was taken to an outside hospital where the reports suggest he had been operated for compartment syndrome and the operative notes say that they found pockets of pus

o/e
valgus deformity at forearm
midline healed surgical incision
movements are normal except ulnar deviation at wrist

x-ray

clinical case

a 30 year old male came with chief complaints of pain in hip since 1 year.swelling since 6 months
no relevant trauma
no weight loss
no loss of appetite
O/E: 40 degree of fixed flexion deformity
         swelling seen and palpable anteriorly and posteriorly
          ROM very painful

what is ur radiological diagnosis
what is ur approach to this case

case 8

A 20 year old female patient presented to our OPD with 

complaints of pain in her left foot since about 10 months and 

swelling in her left foot since 3 months. 

HOPI 

Patient was apparently asymptomatic 10 months back when she developed pain in her foot which is insiduos in onset, of dull aching in nature, aggravated by standing and walking, and relieved by taking rest and/or medication. Pain is of increasing severity and is continuous  since last 2 months. 

Patient developed swelling in her left foot about 3 months back initially diffuse and gradually localized to mid dorsum of foot. There is no history of increase in the size of the swelling.

No h/o trauma

No h/o fever/ weight loss / constitutional symtoms.

No h/o numbness or paraesthesias in the foot.

Past History

No h/o similar complaints i the past.

No h/o TB/ DM/ HTN/ Asthma/ epilepsy/ bleeding disorders.

No h/o past hospitalisation/ surgery

Personal History

Diet mixed

Appetite normal

Sleep disturbed of late due to pain

Family History:

No h/o similar complaints in family members.

No h/o any tuberculous contact.

General examination

20 yr old female who is c/c/c, moderately built and nourished.with pallor,and is without icterus, cyanosis, clubbing,  generalized lymphadenopathy, and pedal edema.

Gait antalgic

Vitals stable

other systems normal

Local examination of her left foot

Inspection

A globular swelling of 3cms diameter is noted over the dorsum of her left mid foot.

swelling is diminishing in size on extension of toes and surface is smooth ,skin over the swelling is normal, no scars and sinuses no visible pulsations, and no local inflammatory signs noted. surroundings are normal.


Palpation:
Local warmth noted,
Deep tenderness noted over the cuneiform bones and the bases over first second third metatarsal.
Swelling site and size are confirmed,skin over the swelling is pinch able and the swelling is uniformly soft  in consistency fluctuant , margins well defined and has minimal mobility in AP and lateral directions. No translucency, neither reducible nor compressible.



Workup and radio graphs attached
MR will be attached shortly

9 months old x rays

Present X rays

Histopathology report of Open biopsy attached

Aspiration yielded straw colored thin fluid which was sterile on microscopy and culture
Open biopsy yielded bits of cheesy material and bony spicules of medial and middle cunieform bones.

What is your clinical radio logical and final diagnosis
how would you like to further manage this patient?

clinical case 7

A 3 and half year old child came for review in opd after 2 years for follow up and review...

Child at the age of 1and1/2 yrs developed DVT of her left lower limb following ? DPT vaccination in thigh for which she received parenteral heparin. Following which hematoma developed in left thigh which got infected in due course of illness got converted to abscess with discharging sinus. ! year following the persistent discharging sinus a x ray  of left thigh showed features suggestive of COM left femur with sequestrum. The child was treated in this hospital for COM with sequestrectomy and saucerisation. 

Now the present x rays and clinical photographs show the remarkable recovery of the child and x ray with hardly any evidence of previous pathology.

case 1 six months followup

Patient after 6 months of ATT Cat I DOTS therapy