Title: February 2018 – Lightning Bolt Artifacts

Submitted By: Lawrence Jankowski, CBDT
Affiliation: Illinois Bone and Joint Institute, LLC

Patient History:
Patient 1: 67 year white female with lumbar stenosis and multi-level lumbar laminectomies and surgical hardware, was referred for DXA scan after a recent Colles’ fracture of her right (dominant) wrist. An osteoporosis consultation through the FLS (Fracture Liaison Service) of the hospital was scheduled, and the patient presented her recent scan report to a rheumatologist.   Hip and forearm images were requested via fax and shown below in figure 1.

Patient 2: 82 year old white female with rheumatoid arthritis with history of multiple periods of 3 month or longer duration and steroid use for rheumatoid arthritis. In response to the intake question to list any prior surgeries to her hips, spine, knees or wrists, she lists two left knee arthroscopic repairs for meniscal tears and chondroplasties, four and six years prior her DXA scan, as well as a right total knee arthroplasty two years prior her DXA. Bilateral hip and spine images are presented in figure 2.


Figure 1: Patient 1 hip and forearm scans (from faxed images). No mention of artifacts are in the accompanying narrative report.


Figure 2: Patient 2: Bilateral hip and spine images and selected BMD results are ahown. Scan comments were provided by the technologist and echoed in the techniqual quality section of the narrative report.

Question

  1. What is the most likely source of these unilateral zig-zag artifacts in the superior greater trochanters in these patients?

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