Lechner Johann, Schick Fabian
Clinic for Integrative Dentistry, Munich, Germany.
Int Med Case Rep J. 2021 Apr 19;14:241-249. doi: 10.2147/IMCRJ.S306641. eCollection 2021.
This paper aims to demonstrate the additional benefit of ultrasound in the diagnosis of chronic osteolysis and osteonecrosis (bone marrow defects) of the jaw shown in a clinical case report.
A case of chronic fatigue syndrome (CFS) in a young man presenting the typical, ambiguous symptoms, which were accompanied by headaches and tinnitus. X-ray techniques, namely panoramic radiographs (OPG) and cone beam computed tomography (DVT/CBCT), failed to produce any remarkable findings of bone marrow defects (BMDJ) in the jawbone. However, the measurement of bone density using trans-alveolar ultrasound (TAU) indicated a possible bone marrow defect in the lower left jawbone.
Surgery was undertaken at the conspicuous area. Additional to softened, ischemic, fatty tissue, a black area was revealed, which was surprisingly subsequently identified as aspergillosis by histopathological analysis. In addition, the excessive local RANTES/CCL5 expression found in the affected area confirmed the necessity for surgical debridement and additional findings of TAU.
In contrast to radiography, complementary TAU imaging of the BMDJ revealed chronic inflammatory signaling RANTES/CCL5 pathways and fungal colonization. This case report supports the need for additional diagnostic techniques beyond radiographic modalities, which can help to elucidate the diagnostic composition and knowledge of the bone manifestations of systemic diseases.
本文旨在通过一份临床病例报告展示超声在诊断颌骨慢性骨质溶解和骨坏死（骨髓缺损）方面的额外优势。
一名患有慢性疲劳综合征（CFS）的年轻男性，表现出典型的、不明确的症状，并伴有头痛和耳鸣。X线技术，即全景X线片（OPG）和锥形束计算机断层扫描（DVT/CBCT），未能在颌骨中发现任何明显的骨髓缺损（BMDJ）。然而，经牙槽骨超声（TAU）测量骨密度显示左下颌骨可能存在骨髓缺损。
在明显区域进行了手术。除了软化、缺血、脂肪组织外，还发现了一个黑色区域，令人惊讶的是，随后经组织病理学分析确定为曲霉菌病。此外，在受影响区域发现的局部RANTES/CCL5过度表达证实了手术清创的必要性以及TAU的其他发现。
与放射成像不同，BMDJ的补充TAU成像揭示了慢性炎症信号RANTES/CCL5途径和真菌定植。本病例报告支持需要超越放射成像方式的额外诊断技术，这有助于阐明系统性疾病骨表现的诊断构成和知识。
