Click the arrow to see the next slide with the correct interpretation.
70-Year-Old Woman with Neck Pain and Swelling
This case features a 70-year-old woman presenting with neck pain and swelling, ultimately diagnosed with medication-related osteonecrosis of the jaw (MRONJ).
Imaging overview:
Coronal and axial contrast-enhanced CT demonstrates an area of lucency with internal sclerosis and sequestrum formation in the mandible, with well-organized periosteal reaction consistent with osteonecrosis. The findings are in the setting of prolonged bisphosphonate use, supporting the diagnosis of MRONJ.
Clinical insight:
MRONJ is most commonly associated with bisphosphonate therapy but can also be seen with biologic cancer therapies and tyrosine kinase inhibitors. Local triggers such as tooth extraction, periodontal disease, or mucosal trauma can precipitate or worsen the condition. A key distinguishing imaging feature of MRONJ compared to osteoradionecrosis (ORN) is the greater degree of osteoblastic activity, reflected by more pronounced periosteal reaction on CT. The differential diagnosis includes osteomyelitis, ORN, and mandibular metastasis, making clinical history of medication use essential for accurate diagnosis.
Case courtesy of Brandon Huddleston, MD, and Siddhartha Gaddamanugu, MD, University of Alabama at Birmingham.