85-year-old patient:
– with long-standing left hip pain
– X-rays requested
Showing images from an MRI
Marked collapse of the articular surface of the left femoral head, along with fragmentation, indicative of osteonecrosis
Secondary dvanced degenerative changes in the hip joint
Reference: Mont MA et al: Nontraumatic osteonecrosis of the femoral head: where do we stand today? A 5-year update. J Bone Joint Surg Am. 102(12):1084-99, 2020
46-year-old patient:
– With right hip pain
– X-rays unremarkable
– MRI requested
Near-complete rupture of the right hamstring tendons with moderate retraction and preserved muscle bellies
Reference: https://radiologyassistant.nl/musculoskeletal/muscle/hamstring-injury
15-year-old patient with left hip pain:
– X-rays requested
MRI
Femoral stress fracture
MRI findings linear low-signal pattern on the medial aspect of the femoral neck, accompanied by bone marrow oedema
Surrounding cortical thickening and solid periosteal reaction
Reference: Shelat NH et al: Pediatric stress fractures: a pictorial essay. Iowa Orthop J. 36:138-46, 2016
35-year-old patient:
– With persistent right hip pain
– Pain exacerbated by abduction/external rotation
– MRI arthrogram requested
Showing images from an MR-arthrography:
There is a complete tear in the anterosuperior labrum, located around the 2 o’clock position.
Reference: Schmaranzer F et al: Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol. 25(6):1721-30, 2014
14-year-old patient:
– With left hip pain
– X-rays unremarkable
– MRI requested
Showing T2W Fat Sat images:
A CT
The MRI revealed a subchondral bone lesion in the superomedial region of the left femoral head, accompanied by noticeable and extensive bone edema in the surrounding area. There is also a minor effusion in the left hip joint.
Differential diagnosis includes either an osteochondral injury or, more likely, osteoid osteoma.
CT confirms the typical features of osteoid osteoma such as subchondral lucency within an internal sclerotic focus and the presence of sclerosis in the surrounding region
Reference: Bhure U et al: Osteoid osteoma: multimodality imaging with focus on hybrid imaging. Eur J Nucl Med Mol Imaging. 46(4):1019-36, 2019
52-year-old patient:
·With chronic right hip pain
MRI findings:
– A subchondral insufficiency fracture accompanied by bone marrow edema is noted
– The presence of additional bone marrow edema in the right femoral neck, particularly in the anterolateral region, is likely indicative of an insufficiency response
– Complete cartilage damage is observed
-Pelvic insufficiency fractures typically manifest in the lateral aspect of the femoral neck, while stress fractures tend to occur on the medial aspect
-Additionally, damage to the articular surface can result from cartilage loss, a condition distinct from osteonecrosis
Reference: Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996
51-year-old patient:
* Present with a painful lump in right thigh
* No history of trauma
* MRI requested
– Perform an X-ray to exclude the presence of calcifications
– Confirm that there is no prior history of trauma
The patient had been involved in a car accident five months before the lump was detected
Perform a follow-up X-ray in three months
Myositis ossificans
It should be distinguished from parosteal osteosarcoma and soft tissue sarcoma
Key imaging characteristics to consider include:
-The zonal phenomenon: Mineralization typically initiates and progresses from the periphery towards the center. The absence of this phenomenon should raise concerns.
-Soft tissue edema is more common around myositis ossificans than around sarcomas. It may show marrow edema, periosteal reaction, and peripheral edema at any stage better expressed
Reference: McCarthy EF et al: Heterotopic ossification: a review. Skeletal Radiol. 34(10):609-19, 2005
66-year-old male:
– Presented with cough and dyspnea
– Known metastatic prostate cancer, under radiological surveillance
Progressive course with veiling basal lung opacities and right pleural effusion.
Widespread metastatic sclerosis of the examined chest wall and upper humeri, scapulae and clavicle.
57-year-old patient:
With recently diagnosed poorly differentiated vaginal carcinoma underwent FDG PET CT for staging
FDG PET/CT study showing:
-A hypermetabolic lower vaginal lesion representing the known vaginal neoplasm associated with a larger hypermetabolic uterine body neoplastic lesion suggesting synchronous malignant process
-Multiple hypermetabolic enumerable bilateral lung deposits associated with a single right lower para-tracheal nodal deposit representing metastatic disease
25-year-old female patient:
– Presented with swollen right cervical lymph nodes
TB cervical lymphadenitis
Mild progression in size of multiple necrotic lymph nodes in bilateral supraclavicular, axillary regions, internal yugular (more prominent at right side).
