eMedicine Specialties > Radiology > Musculoskeletal
Heterotopic Ossification: Multimedia
Updated: Nov 6, 2007
Multimedia
 | Media file 1: Anteroposterior radiograph of the right shoulder in a young man with a painful mass following recent blunt trauma. Soft-tissue swelling is present. A linear band of early mineralization (arrows) is faintly visible. |
 | Media file 2: Delayed image from a technetium-99m (99mTc) methylene diphosphonate bone scan (performed at the time of the first radiograph) demonstrates marked soft-tissue uptake of tracer. |
 | Media file 3: Coronal, oblique, T2-weighted, fast spin-echo magnetic resonance image of the right shoulder obtained on the same day as the initial radiograph. A mass in the soft tissues lateral to the proximal right humerus has a central, heterogeneous, high T2 signal with a surrounding zone of lower signal intensity (arrows). |
 | Media file 4: Anteroposterior radiograph obtained 5 weeks after the initial film demonstrates that maturing peripheral bone (black arrows) has replaced the initial mineralization. The mineralization pattern roughly corresponds with the peripheral low signal seen on magnetic resonance images. A solid periosteal reaction extends distally from the lesion (white arrow). |
 | Media file 5: Noncontrast, axial computed tomography (CT) scan through the proximal thighs in a paraplegic patient with long-standing spinal cord injury. Mature heterotopic ossification surrounds the femoral shafts bilaterally, nearly obscuring the right femur (black arrowhead). A large decubitus ulcer overlies the ossification posteriorly (white arrows). |
 | Media file 6: Noncontrast, axial computed tomography (CT) scan through the hips of a young woman with long-standing spinal cord injury. Large masses of mature heterotopic ossification replace the iliopsoas muscles anterior to both femoral heads. |
 | Media file 7: Anteroposterior radiograph of the left knee in a patient with traumatic brain injury. Mature heterotopic ossification surrounds the medial femoral condyle, with a solid peripheral cortex (arrows). |
 | Media file 8: Anteroposterior radiograph of the right knee in a patient with traumatic brain injury (same patient as in Image 7) demonstrates mature heterotopic ossification in the same distribution as on the left knee. The hips, shoulders, and elbows are more common sites of involvement in the setting of traumatic brain injury. |
 | Media file 9: Longitudinal ultrasonogram of the medial thigh in a 20-year-old patient with paraplegia who has a hard, palpable mass. The heterogeneous, central, hypoechogenic mass is surrounded peripherally by more echogenic material (arrows). A core biopsy under ultrasonographic guidance revealed immature heterotopic ossification (HO). A computed tomography (CT) scan at the time did not demonstrate mineralization, although later radiographs showed typical HO. Courtesy of Dr Robert Lopez, Department of Radiology, University of Alabama at Birmingham. |
 | Media file 10: Attempted frog-leg, lateral radiograph of the left hip. Mature heterotopic ossification (HO) surrounds the greater and lesser trochanters of the femur in this patient, who had a bipolar hip prosthesis placed 2 months earlier. The large amount of HO resulted in a significantly reduced range of motion. |
 | Media file 11: Magnified view of an anteroposterior radiograph of the right tibia in a patient with a palpable anterior mass of the lower leg and a remote history of trauma. Dystrophic-appearing calcifications project over the interosseous membrane and fibular shaft. |
 | Media file 12: Noncontrast, axial computed tomography (CT) scan through a palpable mass demonstrates dystrophic-appearing calcifications scattered throughout a soft-tissue mass in the anterior compartment. An open biopsy revealed heterotopic ossification (HO). While mature HO typically has lamellar peripheral bone in a zonal distribution, bizarre patterns of mineralization also can occur. |
 | Media file 13: Axial computed tomography (CT) scan in a male patient with lower extremity swelling 8 weeks after a spinal cord injury. Peripheral mineralization (arrows) is seen in immature heterotopic ossification within the quadratus femoris muscle. |
 | Media file 14: Corresponding noncontrast, axial, T1-weighted image from a magnetic resonance imaging (MRI) scan performed on the same day as the axial computed tomography (CT) scan (same patient as in Image 13) demonstrates a masslike enlargement of the right quadratus femoris. |
 | Media file 15: Axial, T2-weighted, fast spin-echo, fat-suppressed magnetic resonance image (same patient as in Images 13-14). Extensive edema is present bilaterally in several muscle groups. A high T2 signal alone is a nonspecific finding in patients with spinal cord injury, potentially heralding a site of heterotopic ossification development but often resolving spontaneously. A low signal seen peripherally in the right quadratus femoris (arrow) corresponds to the mineralization observed on the computed tomography (CT) scan seen in Image 13. |
 | Media file 16: Axial, spin-echo, T1-weighted, fat-suppressed magnetic resonance image following intravenous gadolinium administration. In addition to extensive abnormal enhancement surrounding both hips, an unusual nonenhancing area (arrows) is noted anteromedial to heterotopic ossification (HO) demonstrated on computed tomography (CT) scan. The corresponding T2-weighted image does not show a discrete fluid collection in the region. A similar pattern has been seen in association with HO in other patients with spinal cord injuries. |
 | Media file 17: Coronal, T1-weighted magnetic resonance image through the posterior pelvis in a patient with left-sided sciatica. An elongated mass of mature heterotopic ossification (arrowheads) with a peripheral low signal and a central fat signal replaces the proximal hamstrings parallel and adjacent to the sciatic nerve (arrow). |
 | Media file 18: Axial, T2-weighted, fast spin-echo magnetic resonance image through the lower pelvis demonstrates the marrow fat (arrow) within the mature heterotopic ossification (HO) that replaces the semitendinosus and biceps femoris tendons. HO in this region results from a prior ischial tuberosity avulsion injury and can be symptomatic when it impinges on the adjacent sciatic nerve. |
 | Media file 19: Anteroposterior radiograph of the right hip in a 16-year-old boy who had suffered trauma to the hip 2 years previously. The patient is currently experiencing hip pain. Mature heterotopic ossification (arrowheads) projects over and lateral to the femoral head. |
 | Media file 20: Corresponding lateral view of the right hip (same patient as in Image 19). Distal to the mature heterotopic ossification (HO) seen on the anteroposterior view (arrowheads) is a subtle area of early mineralization (arrows) consistent with early HO. |
 | Media file 21: First-pass, or angiogram phase, of a technetium-99m (99mTc) methylene diphosphonate bone scan on a 16-year-old boy (same patient as in Images 19-20) demonstrates no significant abnormality. |
 | Media file 22: Second-pass, blood pool image (same patient as in Images 19-21) demonstrates abnormal uptake in the right femoral head region (white arrow) corresponding to the mature heterotopic ossification (HO) seen radiographically. A second area of uptake over the proximal right femoral shaft (black arrow) correlates with the wispy mineralization of early HO, seen on the lateral view. |
 | Media file 23: Third-phase, delayed image also shows abnormal tracer uptake over the femoral head (arrowhead) and proximal femoral shaft (arrow). |
 | Media file 24: Axial, T1-weighted magnetic resonance image through the proximal, mature heterotopic ossification demonstrates a heterogeneous mass—replacing the rectus femoris and a portion of the iliopsoas—with a central fat signal anterior to the femoral head. |
 | Media file 25: Axial, T2-weighted, short tau inversion recovery (STIR) image (same patient as in Image 24) demonstrates a low signal and shows no appreciable edema. |
 | Media file 26: Axial, T2-weighted, short tau inversion recovery (STIR) image through the more distal area of early mineralization reveals prominent soft-tissue edema consistent with early, immature heterotopic ossification. |
 | Media file 27: Anteroposterior radiograph performed in external rotation of the right shoulder in a 62-year-old female patient. Amorphous calcification is seen superolateral to the humeral head (arrows). The characteristics of this calcification are not indicative of heterotopic ossification (HO); the mature cortical or trabecular structures seen in mature HO are not found, nor are the well-defined margins that are consistent with the immature woven bone of early HO. |
More on Heterotopic Ossification |
| Overview: Heterotopic Ossification |
| Imaging: Heterotopic Ossification |
| Follow-up: Heterotopic Ossification |
 Multimedia: Heterotopic Ossification |
| References |
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Further Reading
Keywords
ectopic ossification, heterotopic bone formation, myositis ossificans, ossifying fibromyopathy, panniculitis ossificans, para-articular ossification, paraosteoarthropathy, periarticular new bone formation, HO
