50歲，男性，患者長(zhǎng)期雙下肢疼痛腫脹，有風(fēng)力發(fā)電廠暴露史

Long-standing bilateral leg pain and swelling. History of wind farm exposure.

2020 April Fools case

這個(gè)病例來(lái)源于Radiopaedia的愚人節(jié)病例，該病例并非真實(shí)，請(qǐng)注意以上聲明，因?yàn)槲覀儗⒁_始“談學(xué)術(shù)”了。如果真信了我們的討論，鼎湖影像將不對(duì)此負(fù)責(zé)

結(jié)果公布：Resonance imparted periostitis (RIP) 共振性骨膜炎

Case Discussion

Images pathognomonic of resonance imparted periostitis (RIP), in this case secondary to wind turbine exposure rather than the more common nautical wave exposure responsible for bow legged sailors. The 15cm wavelength of undulation matches the low frequency output of modern wind turbines. 

根據(jù)影像特征該病例可診斷為共振性骨膜炎，該病例繼發(fā)于風(fēng)力渦輪機(jī)暴露而非航海雷達(dá)聲波的暴露。15厘米的波長(zhǎng)與風(fēng)力渦輪機(jī)的低頻輸出相匹配。

This patient self-presented concerned he may have RIP after seeing recent reports on TV and social media. He has lived near a wind farm for over 20 years and experienced progressive bilateral leg pain over 2 to 3 years. On examination, movement and strength were normal. Hard, moderately-tender, subcutaneous undulations over his shins were palpable. Radiographs showed classic sine wave cortical deformity and active resonant periostitis.

患者自述其最近在電視和社交媒體上看到相關(guān)報(bào)道，擔(dān)心自己可能患有共振性骨膜炎可能?；颊咴陲L(fēng)電場(chǎng)附近生活了20多年，近2-3年，漸進(jìn)性雙側(cè)下肢腿痛。查體運(yùn)動(dòng)和肌力正常。其小腿可觸及堅(jiān)硬的、中等柔軟的皮下波浪性改變。X線片顯示典型的正弦波皮質(zhì)畸形和活動(dòng)性共振性骨膜炎。

While the prevalence of RIP has reduced dramatically over the last 100 years with changes in maritime behavior, it is now undergoing a resurgence due to the proliferation of clean energy. The deformity is most prominent in the lower limbs, supporting the theory that direct transmission of mechanical impulses via the ground is the causative agent. Milder deformity may be seen more cephalad in the skeleton due to dissipation of the oscillatory energy.

盡管100年來(lái)，由于海洋行為的變化，RIP的發(fā)病率明顯降低。但由于清潔能源的廣泛應(yīng)用，該病又開始盛行。下肢畸形最為突出，病因可能是機(jī)械脈沖通過(guò)地面直接傳遞。由于振蕩能量的耗散，頭側(cè)的骨骼畸形較輕 。

Case reports suggest differing osseous wavelengths depending on the types of wind turbines in use in different parts of the world. For example, British people with the disease tend to have a wavelength close to 12 cm whereas Dutch people (where the turbine association was first described) have a wavelength closer to 18 cm as their wind turbines are taller with longer blade lengths. 

病例報(bào)告表明，不同的骨性波長(zhǎng)取決于世界不同地區(qū)使用的風(fēng)力渦輪機(jī)的類型。例如，患有這種疾病的英國(guó)人的波長(zhǎng)往往接近12厘米；而荷蘭人(他們的渦輪機(jī)協(xié)會(huì)首先被描述)的波長(zhǎng)接近18厘米，因?yàn)樗麄兊娘L(fēng)力渦輪機(jī)更高，葉片更長(zhǎng)。

A strong association has emerged between RIP and renal colic, with ureteric stones forming ~15cm and ~30cm from the vesicoureteric junctions; at nodes of standing waves that travel through the ureter. Patients have also reported an uncommon form of vertigo when supine, where they describe the room spinning in the vertical plane, rather than the more common horizontal spinning room encountered in acute ethanol poisoning.

RIP與腎絞痛之間存在較強(qiáng)的相關(guān)性，約15cm ~30cm的輸尿管結(jié)石形成于膀胱輸尿管交界處。患者還表現(xiàn)為一種少見的仰臥時(shí)眩暈，他們描述的是在垂直平面上旋轉(zhuǎn)，而不是急性酒精中毒時(shí)更常見的水平旋轉(zhuǎn)。

Importantly, a social media-fueled hoax suggesting that this condition is due to Magnetic Resonance Imaging scanners has no factual basis and has led to unwarranted concern over the use of 3 T and 7T MRI. The Radiological Action Group of Scotland (RAGS) recently launched a highly successful and entertaining video campaign dispelling any link between MRI and RIP entitled “Never gonna give you up”. 

社交媒體們紛紛推波助瀾認(rèn)為該病是由于磁共振成像引起，這種說(shuō)法完全沒(méi)有事實(shí)依據(jù)，還引起了人們對(duì)3T和7T磁共振使用的擔(dān)憂。RAGS最近發(fā)起了一個(gè)題為“永遠(yuǎn)不會(huì)放棄你”的活動(dòng)，成功消除了人們對(duì)MRI和RIP之間有關(guān)聯(lián)的認(rèn)識(shí)。

該病非常典型，見一次就將過(guò)目不忘！你學(xué)會(huì)了嗎？