Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update

[Inflammatory muscle diseases (myositis)]

CLINICAL ISSUE

Inflammatory muscle diseases are quite heterogeneous and frequently a specific diagnosis is not easy.

STANDARD RADIOLOGICAL METHODS

Magnetic resonance imaging (MRI) is best suited to demonstrate pattern and size of inflamed muscles.

PERFORMANCE

Sensitivity of MRI in showing inflamed muscles is nearly 100%. Specificity, however, is much lower.

PRACTICAL RECOMMENDATIONS

In cases of suspected bacterial myositis, sonography may be used to exclude abscess formation prior to MRI for more precise information about inflamed muscles.

Multifocal metastatic chordoma to the soft tissues of the fingertips: a case report including sonographic features and a review of the literature

Chordoma is a rare, locally aggressive tumor which commonly metastasizes, most often to the lung, liver, and spine. In this case report, a 59-year-old male with history of sacral chordoma and pulmonary metastases presented to the emergency department with swelling and discoloration of multiple left fingertips. The initial radiographs led to a presumptive diagnosis of gout, which did not respond to medical therapy. An ultrasound demonstrated multiple solid masses with vascular hyperechoic septations which were subsequently biopsied and proven to be metastatic chordoma. Metastatic disease to the hand is a well documented but rare manifestation of many malignancies. The clinical presentation and radiographic features of multifocal hand metastases may mimic entities such as systemic deposition and granulomatous diseases. To the best of our knowledge, this is the first case report of soft tissue chordoma metastases to the fingertips as well as the first reported sonographic description of chordoma metastases.