Incidental intraosseous pneumatocyst.
Article Type: Case study
Subject: Cysts (Risk factors)
Cysts (Diagnosis)
Cysts (Care and treatment)
Cysts (Patient outcomes)
Cysts (Case studies)
Sacrum (Abnormalities)
Sacrum (Medical examination)
CT imaging (Usage)
CT imaging (Health aspects)
Authors: Master, Mobin
Keshava, Shyamkumar
Pub Date: 01/01/2010
Publication: Name: Applied Radiology Publisher: Anderson Publishing Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Anderson Publishing Ltd. ISSN: 0160-9963
Issue: Date: Jan-Feb, 2010 Source Volume: 39 Source Issue: 1-2
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 231310691
Full Text: CASE SUMMARY

A 55-year-old patient presented with acute loin pain and hematuria, suggestive of right ureteric colic. Intravenous urogram showed a distal right ureteric calculus. His symptoms subsided and there was no calculus. On follow-up, noncontrast computed tomography (CT) indicated spontaneous passage. Incidentally, a well-defined lytic lesion was seen in the sacrum adjacent to the left sacroiliac joint consistent with a pneumatocyst.

IMAGING FINDINGS

A radiograph of the pelvis showed a rounded well-defined lytic lesion in the sacrum, adjacent to the left sacroiliac joint in addition to the radio-opaque calculus in the distal ureter (Figure 1). It measured approximately 11 mm with a thin well-defined sclerotic margin. Axial and coronal CT showed the air density within the lesion (Figures 2 and 3). The sacroiliac joint was unremarkable.

DIAGNOSIS

Incidental intraosseous pneumatocyst

DISCUSSION

Intraosseous pneumatocyst is a rare benign condition, commonly seen in iliac bone or sacrum. (1,2) Locations like vertebral bodies, clavicle, acetabulum also have been mentioned. (2,3,4,5) The etiology of pneumatocyst is unclear.

Some have suggested that the cause is spontaneous development of intraosseous gas or vacuum degeneration of an underlying intraosseous ganglion or synovial cyst. Laufer et al. speculated that the gas in the cyst is nitrogen released from the adjacent joints. (6) Gas in the pneumatocyst may disappear spontaneously, and the cyst might change to a fluid-filled cyst. Subsequently, the cyst might be replaced with granulation tissue. (4)

CONCLUSION

Intraosseous pneumatocyst should be differentiated from bone neoplasms and osteomyelitis by its characteristic imaging findings. Intraosseous pneumatocysts are benign lesions, therefore biopsy and follow-up are unnecessary.

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REFERENCES

(1.) Catalano O, De Rosa F, Muto M. Intraosseous pneumatocyst of the ilium: CT findings in two cases and literature review. Eur Radiol. 1997;7: 1449-1451.

(2.) Berenguer J, Pomes J, Bargallo N. Sacral pneumatocysts: CT appearance. J Comput Assist Tomogr. 1994;18(1):95-97.

(3.) Kitagawa T, Fujiwara A, Tamai K, et al. Enlarging vertebral body pneumatocysts in the cervical spine. AJNR Am J Neuroradiol. 2003;24: 1707-1710.

(4.) Yamamoto T, Yoshiya S, Kurosaka M, et al. Natural course of an intraosseous pneumatocyst of the cervical spine. AJR Am J Roentgenol. 2002; 179:667-669.

(5.) Linker CS, Peterfy CG, Helms CA. Case report 844. Intraosseous pneumatocyst of the clavicle. Skeletal Radiol. 1994;23:315-316.

(6.) Laufer L, Schulman H, Hertzanu Y. Vertebral pneumatocyst: A case report. Spine. 1996;21: 389-391.

Mobin Master, MBBS, and Shyamkumar Keshava, DMRD, DNB

Prepared by Mobin Master, MBBS, and Shyamkumar Keshava, DMRD, DNB, The Queen Elizabeth Hospital, Woodville, South Australia.
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