Musculoskeletal #22

What do you see?

Click here to see the answer

Vertebral hemangioma with thickened trabeculae and fat foci inside the lesion, without soft tissue component with an associated pathological fracture.

TEACHING POINTS:
Bone hemangiomas are very frequent, atypical presentations and complications (like in this cases with soft tissue component and pathological fracture) are rare but radiologist must be aware of them to be able to make the correct diagnosis.

Neuroradiology #30

A 6-year-old boy presenting to emergency department with headache, nausea, and vomiting

What do you see?

Intra-axial cystic lesion with mass effect shows CSF signal intensity on all sequences, without enhancement and perilesional edema

Differential diagnosis include

* Parasitic diseases (hydatid cyst) spheric
* Neuroglial cyst may have surrounding gliosis
* Porencephalic cyst surrounding gliosis, communicates with ventricle

Same cystic lesion in superior lobe of left lung

What is the most likely diagnosis?

Hydatid cyst disease
Both lesions were treated by surgery

New Webinar from Prof. Cáceres – SOLVED

Prof. Cáceres is preparing a new webinar about the “Pulmonary fat, my friend”. Join him this Wednesday June 16th at 12:00 CEST. He will discuss the case presented here, among others. Register here.

Dear Friends,

Today’s radiographs belong to two different patients with peripheral opacities of the chest. What would be your diagnosis?

1. A is fat and B solid tissue
2. B is fat and A solid tissue
3. Both are fatty
4. Need a CT

Click here to see the answer

Findings: Radiograph of case A shows an opacity in the left upper lung. Its inner contour is outlined by air (arrow) and the outer border is not visible (asterisk) suggesting an extrapulmonary lesion (incomplete border sign).
CT shows that the opacity represents extrapleural fat (B, arrow).

Radiograph of the second case shows a well-defined rounded opacity (C, arrow), that was interpreted as a peripheral pulmonary nodule. PET-CT was done, and the apparent pulmonary nodule was shown to be extrapleural fat (D, arrow).

 
These two cases are shown to emphasize that fat in or around the lung cannot be distinguished from soft tissues in the plain chest radiograph. To recognize fat, CT is necessary.
 
More information about fatty lesions of the lung is given in the webinar “Mediastinal fat: my friend” that will be published soon on the EBR youtube channel.

Musculoskeletal #21

65-year-old man. Paraplegia after skiing accident. What do you see?

Click here to see the answer

Imaging findings

Complete low dorsal transdiskal and transvertebral fracture with extension to middle and posterior columns on an ankylosed spine.
Sever posterior angulation and displacement of the superior segment cord deformity, compression and myelopathy.

Diagnosis

Severe complete unstable ankylosed spine fracture with cord compression and mielopathy

Teaching points

Ankylosed spine show specific patterns of fracture with: higher tendency to three column involvement, and increased frequency of neurologic complications.

Neuroradiology #29

An 89-year-old female patient with aplastic anemia. What do you see?

Click here to see the answer

CT images without contrast media: Subacute isodense right subdural hematoma, revealed with narrowing of right cerebral hemispheric sulci and right lateral ventricle and minimal midline shift (red arrows), acute left subdural hematoma (blue arrow)

Musculoskeletal #20

72-year-old alcoholic patient with intractable dorsal pain and legs numbness and weakness.

What do you see?

Click here to see the answer

IMAGING FINDINGS:

Thoracic spine compression fracture with posterior displacement of the posterior wall of the vertebral body compromising the spinal canal, cord compression and associated myelopathy. T2W image shows fluid and hypointense bubble-like artifact consistent with vacuum cleft in the collapsed anterior vertebral body

DIAGNOSIS:

Kümmel disease (osteonecrosis and collapse of the vertebral body)

TEACHING POINTS:

Intravertebral vacuum cleft and fluid within the collapsed vertebral body is a characteristic feature
Differential diagnosis includes a pathologic (tumoral) fracture, and the presence of air strongly favors osteonecrosis

Would you like to see a complementary case?

Click here


MR T2-weighted and CT images to highlight the characteristic features of Kümmel disease

Intravertebral fluid seen on T2 image and air on CT image

Neuroradiology #28

A 24-year-old female patient with headache. What do you see?

Click here to see the answer

Multinodular and vacuolating neuronal tumor (MVNT): Cortical ribbon-juxtacortical T2 hyperintense (a-b) round to oval nodular lesions, not suppressed on FLAIR images (c) and usually no enhancement (d) may show fair enhancement rarely, without diffusion restriction (not shown)