What do my lab reports indicate?

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Posted on Tue, 16 Jun 2015 in Back Pain
Question: Hi,

Patient was experiencing pain in ribs for 10 years.
Please find below the reports:

10 Year Old XRAY Report:
Fibrous Dysplasia noted in right 3rd rib

Recent Reports:

XRAY REPORT:
============

Right 2nd and 3rd ribs shows ill defined sclerotic lesions in antero lateral aspect.
Small lytic area are noted within.
No other focal lesion in the visualized bones
No evidence of fracture
Lungs are clear
Hila are normal
CP angles are clear
Domes of Diaphragm are normal

Impression:
Recommended clinical correlation and further evaluation

CT CHEST/RIBS FINDINGS:
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Anterior chest wall deformity is noted on the right.
The 2nd and 3rd right anterior ribs are expanded and demonstrate multiple lytic foci with evidence of cortical erosion.
There is associated soft tissue thickening and stranding in the intercostal regions.
Rest of the ribs, sternum and the other visualised bones are within normal limits.
Dependent changes are seen in the lungs.
No focal lung lesion is seen.No pleural abnormality.
No significant upper abdominal abnormality.

MRI OF THE CHEST FINDINGS:
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Correlation is made with the CT performed on the same day.
MRI confirms the presence of expansile lytic lesions in the right 2nd and 3rd anterior ribs with associated soft tissue components.
Unremarkable appearances of the sternoclavicular joints.

IMPRESSION:
Expansile, lytic lesions in the right sided 2nd and 3rd anterior ribs with associated soft tissue thickening/oedema. Appearances are suggestive of an infectious etiology. Suggest biopsy for confirmation.

FNAC Report
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US guided FNA of right anterior chest wall swelling involving 2nd and 3rd ribs
Smears are predominantly haemorrhagic consisting of few muscle fragments and few inflammatory cells. Epithelioid cell granuloma or malignant cells are not present.

Had tried AKT4 for 2 months and pain increased a lot. Then AKT4 was discontinued. Patient is off AKT4 for around a month now. Excision Biopsy will be done soon.
Qstn 1: What is the recovery period before patient can go back to normal routine after excision biopsy is done.
Qstn 2: Is the procedure complicated for excision biopsy ?
doctor
Answered by Dr. Praveen Tayal 55 minutes later
Brief Answer:
Usually heals in 3-4 weeks.

Detailed Answer:
Hello,
Thanks for posting your query.
1. After an excision biopsy, it takes 3-4 weeks for the bone to heal properly. However the patient can do her daily activities in 7-10 days. The pain gradually subsides by then and the bone starts healing. The recovery period may be more if the lesion is a large one or there is any infection.
2. The chest wall resection and reconstruction is a complicated procedure and an experienced surgeon in the field is needed to perform the surgery. A proper reconstruction of the area is needed for the patient to breathe normally.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 17 hours later
Will both the affected bones be removed or first the biopsy result would come and then another surgery maybe required ?
doctor
Answered by Dr. Praveen Tayal 7 hours later
Brief Answer:
Both the ribs should be removed.

Detailed Answer:
Hello.
Thanks for writing again.
Both the affected ribs should be removed in a single surgery. If only a minor piece is taken then no reconstruction of chest wall is required and it will be a minor operation in that case.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12049 Questions

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