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Scapular stress fracture

Case contributed by David Llopis
Diagnosis probable

Presentation

Unexplained pain in right posterior rib cage, not responding to treatment.

Patient Data

Age: 40 years
Gender: Male
x-ray

Chest X-ray shows no abnormal findings in the rib cage.

Nuclear medicine

Early polyarticular disease is seen in many joints, appearing symmetrical and of age-coherency scintigraphy pattern. It flagged a single hot spot in right scapular area.

mri

MRI shows a disruption step along the axillary border of the right scapula, demonstrated in axial T1 and sagittal T2. No edema evidence in fluid sensitive series.

Case Discussion

Chest and oblique X-ray without abnormal findings. A bone scan was performed because the upper back pain persisted, and despite polyarticular uptake, we focussed on a single hot spot in the right scapular area, not present on the contra-lateral side. MRI shows the cortical disruption corresponding to the abnormal uptake on the bone scan suggesting a stress fracture.

This is an unusual location for a stress injury. The underlying mechanism is not known with the patient having a normal bone mineral density and no history of overuse.

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