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Case of the Week 103

Case of the Week 103. Adult female patient with a chronic MSK condition brings this chest radiograph with her. Try to make the diagnosis from this view alone. What is the DDX for the finding pointed out by the arrows?. Answers. DX:

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Case of the Week 103

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  1. Case of the Week 103 Adult female patient with a chronic MSK condition brings this chest radiograph with her.

  2. Try to make the diagnosis from this view alone. What is the DDX for the finding pointed out by the arrows?

  3. Answers • DX: • This patient has long-standing Rheumatoid arthritis. Although the shoulder girdle is distorted on the PA chest radiograph normally, both of her humeri are displaced superiorly and the distal clavicles are eroded bilaterally. Additionally, the arrows point out erosions of the posterior aspects of ribs 2 – 5 bilaterally, worse on the right. • DDX of posterior rib erosions. • RA, Scleroderma, Hyperparathyroidism. This is the same DDX for bilateral erosions of the distal clavicles. It is the significant superior displacement of the humeri (bilateral rotator cuff tears) that clinches the diagnosis of RA. Of course you would have already known this from your history and physical examination.

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