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Zivadinovic JD, Stojanovic MM, Stosic MD, Zivadinovic AR, Jankovic R, Gmijovic MD, Golubovic I, Stosic B, Ignjatovic NS, Stojanovic MP. Subcutaneous and Intraosseous Fat Necrosis Associated with Chronic Pancreatitis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060802. [PMID: 35744065 PMCID: PMC9227301 DOI: 10.3390/medicina58060802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Background: Extra-abdominal manifestations of fat necrosis, like subcutaneous fat necrosis, polyarthritis, and polyserositis may appear with an occurrence rate of about 0.8%, wherein intraosseous fat necrosis is a more rare complication of pancreatitis, with few reports in English literature. Case report: A 34-year-old male with a 15-year-history of alcohol abuse was hospitalized several times in the last few years because of attacks of relapsed chronic pancreatitis. After the last attack, pancreatitis came in a stable state (“burned out”) with no symptoms and signs of the disease. The patient had been free of symptoms for 28 months since the last admission when he came with sub-febrile temperature, huge pain, swelling, and erythema in the area of the left lateral malleolar region with propagation in the foot. Blood biochemistry was normal. Conventional radiography showed multiple sites of osteolysis in the left calcaneus. Images on multislice computed tomography (MSCT) with 3D reconstruction revealed hypodense focuses that corresponded to osteonecrosis areas and bone marrow edema in the left calcaneus. Conclusions: The possibility of intraosseous fat necrosis should be considered in situations of unexplained polyarthritis or panniculitis, particularly in individuals with alcohol abuse or pancreatic disease.
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Affiliation(s)
- Jelena D. Zivadinovic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
- Correspondence:
| | - Marko M. Stojanovic
- Gastroenterology and Hepatology Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia;
| | - Marija D. Stosic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Aleksandar R. Zivadinovic
- Clinic for Gynecology and Obstetrition, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia;
| | - Radmilo Jankovic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Marko D. Gmijovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Ilija Golubovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Biljana Stosic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Nebojsa S. Ignjatovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Miroslav P. Stojanovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
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What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature. Asian Spine J 2018; 12:586-599. [PMID: 29879789 PMCID: PMC6002160 DOI: 10.4184/asj.2018.12.3.586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.
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