Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant
Abstract
Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus frature, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.
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- Rice bodies were initially identified in 1895 in a patient with TB infection [1][2]. Grossly, rice bodies appear as grains of polished rice [1][2][3]. They are composed of an acidophilic collagenous center and are encased in fibrin [1].
[Show abstract] [Hide abstract] ABSTRACT: Most commonly associated with chronic inflammatory conditions, rice bodies represent an uncommon, nonspecific, often intra-articular inflammatory process. Presumably, rice bodies represent the sequelae of microvascular infarcts of the joint synovium. However, rice bodies have been seen in pleural fluid, in the setting of bursitis, and within the tendon sheath. The etiology and prognostic significance of rice bodies are not clear. MRI is the diagnostic imaging modality of choice for the evaluation of rice body formation. Here we present a case of a 28-year-old female with a history of rheumatoid arthritis (RA) who presented to her primary care physician with a palpable mass around her right shoulder which was presumed to be a lipoma. An initial ultrasound showed a fluid filled structure with internal debris. Subsequent MRI evaluation was confirmatory for subacromial-subdeltoid bursitis with rice body formation. The salient point of this report is to highlight the importance of patient-specific differential diagnosis. While lipomas are a very common benign soft tissue tumor, patients with RA often have disease-specific sequelae that should be included in the diagnostic deliberation. Thus, when ordering diagnostic testing for patients with a palpable mass and rheumatoid arthritis, MRI--possibly preceded by conventional radiography--is the most appropriate diagnostic algorithm.- Osteoarthritis is a very rare entity associated with rice bodies [10]. Rice bodies have also been reported, though very rarely, in association with foreign bodies like orthopaedic implants and prosthesis [11, 12]. There are not many reports of rice bodies associated with tubercular arthritis in the orthopaedic literature.
[Show abstract] [Hide abstract] ABSTRACT: Rice bodies are most of the times encountered in rheumatological disorders. They have also been seen in tuberculosis, though rarely. With tuberculosis, rice bodies are usually associated with bursae and tenosynovium and very rarely with large joints. We report a rare case of intra articular rice bodies associated with tuberculosis of the knee joint that mimicked monoarticular rheumatoid arthritis and pigmented villonodular synovitis clinically, with absent constitutional and laboratory features suggestive of tuberculosis.- [Show abstract] [Hide abstract] ABSTRACT: Tuberculous tenosynovitis and bursitis account for approximately 1%. A 56 years old female presented with swelling in left shoulder, gradually increasing in size with slight restriction in movement since last three months. X-ray revealed no abnormality of humerus head. Histopathological examination showed granulomatous tissue with multiple rice bodies. A positive culture of mycobacterium tuberculosis confirmed the diagnosis of tuberculosis. We here report a case of subdeltoid bursitis with rice body formation and without active bone and joint tuberculosis.
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