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| A 72 year old woman
presented to her family physician with postmenopausal bleeding.
An endometrial biopsy was performed in Sept. 2002 which returned as complex
hyperlasia without atypia. She was then scheduled for a
total hysterectomy with removal of the ovaries.
A D&C performed prior to her surgery returned as carcinosarcoma.
The uterine specimen show a mixed mesodermal tumor with minimal
superficial invasion of the myometrium. She is status post
radiation which was completed in January 2003.
On Sept. 16, 2003 she reports that she
had a fall 2 months ago and hurt her right hip. Now she
reports increasing back pain that is not getting better. She
is status post occupational therapy. She denies any changes
in bowel or bladder habits. No vaginal bleeding or
discharge. No weight loss. No decrease in appetite.
She is scheduled for a bone scan. |
 |
 Click
here for magnification |
| Radiology
Report: |
| Following IV
administration of 28.4 mCi of 99mTc HDP, anterior and
posterior whole body images were obtained at approximately two
hour delay. Areas of
increased activity are seen in both SI joints and transversely
across the body of the sacrum demonstrates appearance of the
"Honda sign". No other area of abnormal increased
activity is noted. There is physiologic uptake
seen in the kidneys and urinary bladder.
IMPRESSION: INSUFFICIENCY
STRESS FRACTURE INVOLVING THE PELVIS. |
| "Honda Sign" |
 |
In the sacrum, stress fractures are
associated with osteoporosis or prior radiation therapy to the pelvis
(an insufficiency fracture). The osteoporotic sacrum develops a
characteristic fracture with fracture lines running vertically through
the left and right sides of the bone just medial to the SI joints, in
conjunction with a transverse fracture just below the level of the SI
joints. The fractures appear as a hot, geographic lesions confined to
the sacrum and often have a characteristic "butterfly" or "Honda
sign" appearance. Plain film are typically normal, but may
show a sclerotic lesion.
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© 2003 Nuclear Education Online
Images courtesy of UAMS Dept of
Nuclear Medicine.
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