The Journal of Bone and Joint Surgery (American) 84:800-803 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Heavy Metal Injection Granulomas: A Source of Diagnostic Confusion
A Composite Case Report
Junichi Tamai, MD and
James A. Shaw, MD
Investigation performed at The George Washington University
Medical Center, Washington, D.C.
Junichi Tamai, MD
Children's Hospital of Philadelphia, 34th and Civic Center Boulevard,
Philadelphia, PA 19034
James A. Shaw, MD
7817 Tomlinson Avenue, Cabin John, MD 20818
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
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Introduction
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Prior to the introduction of penicillin in the 1940s, syphilis was
treated primarily with heavy metal injections. Once commonplace,
the characteristic gluteal injection deposits visible on radiographs
are now seen only occasionally and, therefore, may result in a diagnostic
enigma to younger orthopaedic surgeons. An informal survey of orthopaedic
residents and younger faculty members at our institution who were
asked to identify the radiopaque deposits seen in
Figures 1-A
,
1-B
,
1-C
, and
1-D
) revealed a 0% recognition rate. Since patients with a history of
syphilis who were originally treated with heavy metal injections
still are seen on occasion by an orthopaedic surgeon, it is important
that younger orthopaedists become reacquainted with the characteristic
radiographic appearance of these injection granulomas.
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Fig. 1-A: Figs.
1-A through 1-D
Recent radiographs of four patients who were between seventy and
eighty years old, demonstrating heavy metal (bismuth) injection
granulomas in the gluteal muscles. . . . [Full Text of this Article] |
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