Images in Clinical Rheumatology
Unusual Clinical Complication: Acute Lower Limb Ischemia Caused by a Tibial Osteochondroma
Complicación clínica inusual: isquemia aguda de miembro inferior causada por osteocondroma tibial
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Sagittal slice. Maximum intensity projection (MIP). Thrombosis of the popliteal artery (arrow) with distal rechanneling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A male, 67 years of age, obese, with high blood pressure and dyslipidemia presented at the emergency department due to pain, cold and functional impairment of his lower left limb of 24-h onset. During anamnesis, the patient stated he had had a chronic intermittent pain in his left knee for a long time. A previous simple knee X-ray showed an osteochondroma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient presented with a femoral pulse but with no popliteal and distal pulses. Artery examination was normal in the contralateral extremity. A CT angiogram was requested for the lower limbs which showed thrombosis of the popliteal artery adjacent to the osteochondroma (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). We decided to perform in situ revascularization with femoro-popliteal saphenous vein graft (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) avoiding the tunneling technique for anatomical positioning. To date, after 3 years of follow-up with eco-Doppler, the bypass continues maintaining permeability with ankle-arm index of 0.9, and no signs of popliteal vein injury.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Osteochondroma is the most common pseudotumoral bone lesion. The radiologic pathognomonic characteristic of this tumor is the cortical and medullar continuity of the lesions with the bone from which they protrude.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> They may be single or multiple.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Some of the most common complications are the presence of bone deformity, fractures,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> vascular compromise<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and neurological compromise,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> formation of a bursa<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and malignant degeneration.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Diagnosis may be made with an X-ray, although other imaging methods such as a scan, CT and MR may be used in suspected cases when symptoms occur or are in unusual locations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Vascular compromise may be caused by displacement of blood vessels (arteries and veins), by stenosis, occlusion and the formation of pseudoaneurisms, with the latter being more frequent at knee level,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> involving the popliteal artery or being presented as arterial thrombosis,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> as in this clinical case. Its presentation as thoracic outlet syndrome in the case of rib lesions has been described.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Familiarity with the spectrum of radiological findings leads to an accurate diagnosis which is helpful in managing the patient toward appropriate treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Liabilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments using human beings or animals have been carried out for this research study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their center of work on patient data publication.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they obtained the informed consent from the patients and/or subjects referred to in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Liabilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-14" "fechaAceptado" => "2017-03-03" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alonso-Gómez N, Cuesta-de Diego M, Martínez-Izquierdo A, Sáinz-González F. Complicación clínica inusual: isquemia aguda de miembro inferior causada por osteocondroma tibial. Reumatol Clin. 2019;15:182–184.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 996 "Ancho" => 850 "Tamanyo" => 52161 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lateral X-ray of the knee: exophytic bone lesion (arrow) tibia-dependent corresponding to an epiphyseal osteochondroma.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 787 "Ancho" => 1400 "Tamanyo" => 59200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT angiogram of MMII. Axial slice. Posterior displacement of the left popliteal artery (circles).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 870 "Ancho" => 850 "Tamanyo" => 36077 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT angiogram. Sagittal slice. Maximum intensity projection (MIP). Thrombosis of the popliteal artery (arrow) with distal rechanneling.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 728 "Ancho" => 1600 "Tamanyo" => 92400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Eco-Doppler: bypass control. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 16 | 22 |
| 2024 October | 36 | 27 | 63 |
| 2024 September | 42 | 23 | 65 |
| 2024 August | 60 | 31 | 91 |
| 2024 July | 49 | 34 | 83 |
| 2024 June | 48 | 31 | 79 |
| 2024 May | 42 | 30 | 72 |
| 2024 April | 63 | 25 | 88 |
| 2024 March | 70 | 38 | 108 |
| 2024 February | 56 | 23 | 79 |
| 2024 January | 60 | 20 | 80 |
| 2023 December | 48 | 25 | 73 |
| 2023 November | 54 | 28 | 82 |
| 2023 October | 51 | 22 | 73 |
| 2023 September | 105 | 45 | 150 |
| 2023 August | 97 | 19 | 116 |
| 2023 July | 64 | 26 | 90 |
| 2023 June | 42 | 19 | 61 |
| 2023 May | 55 | 20 | 75 |
| 2023 April | 44 | 10 | 54 |
| 2023 March | 70 | 22 | 92 |
| 2023 February | 65 | 23 | 88 |
| 2023 January | 47 | 24 | 71 |
| 2022 December | 73 | 24 | 97 |
| 2022 November | 66 | 15 | 81 |
| 2022 October | 59 | 28 | 87 |
| 2022 September | 54 | 34 | 88 |
| 2022 August | 29 | 27 | 56 |
| 2022 July | 44 | 34 | 78 |
| 2022 June | 35 | 32 | 67 |
| 2022 May | 37 | 37 | 74 |
| 2022 April | 31 | 44 | 75 |
| 2022 March | 43 | 32 | 75 |
| 2022 February | 46 | 31 | 77 |
| 2022 January | 62 | 41 | 103 |
| 2021 December | 32 | 45 | 77 |
| 2021 November | 29 | 38 | 67 |
| 2021 October | 68 | 67 | 135 |
| 2021 September | 42 | 34 | 76 |
| 2021 August | 28 | 39 | 67 |
| 2021 July | 25 | 27 | 52 |
| 2021 June | 37 | 23 | 60 |
| 2021 May | 41 | 46 | 87 |
| 2021 April | 73 | 109 | 182 |
| 2021 March | 51 | 32 | 83 |
| 2021 February | 33 | 19 | 52 |
| 2021 January | 19 | 11 | 30 |
| 2020 December | 32 | 22 | 54 |
| 2020 November | 41 | 21 | 62 |
| 2020 October | 20 | 15 | 35 |
| 2020 September | 38 | 24 | 62 |
| 2020 August | 21 | 25 | 46 |
| 2020 July | 14 | 18 | 32 |
| 2020 June | 37 | 21 | 58 |
| 2020 May | 22 | 9 | 31 |
| 2020 April | 27 | 16 | 43 |
| 2020 March | 17 | 8 | 25 |
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