A 55-year-old male. Pain left flank and macroscopic hematuria.
What is your diagnosis?
Diagnosis: Left hydronephrosis and hydroureter with proximal obstructing ureter stone. Fat stranding surrounding left kidney, “blow out” of urine
Elbow pain after a fall. What do you see?
Large joint effusion with the displacement of the anterior fat pad. Mild posterior soft tissue swelling over the olecranon. Fracture line along the lateral aspect of the radial neck. Radial head and articular surface are normal
Nondisplaced radial head fracture
– Check not only the bones and joints but also the soft tissues
– Search and interpret the findings in two different positions
– Pain always withholds a story behind
2-year-old girl, referring to emergency department after a fall.
What do you see?
– An expansile lytic lesion with ill-defined margins (green arrow) is seen on the diaphysis of fibula.
– Lamellated periosteal reaction (red arrow) suggests an aggressive lesion.
Differential diagnosis of an aggressive lytic lesion in a 2-year-old child includes:
– Ewing’s sarcoma
– Langerhans cell histiocytosis
An MRI scan
Intramedullary hyperintense lesion with extensive surrounding soft tissue and bone marrow edema on coronal STIR image (a) is seen. The lesion is hypointense on T1 WI (b).
Postcontrast coronal (a) and axial fat-suppressed (b) T1-weighted images show extensive enhancement in the lesion and the surrounding soft tissue
Histopathologic examination revealed Langerhans cell histiocytosis.
– LCH is characterised by idiopathic infiltration and accumulation of abnormal histiocytes within various tissues.
– Bone is the most commonly affected tissue in children, with a predilection for axial bones, and femur is the most commonly affected long bone.
– Radiographic appearance of the lesions depends on the site of involvement and the phase of the disease.
– Skull: Calvarium is more affected than the skull base, typically seen as single or multiple well-defined lytic lesions on radiography; T1 hypointense, T2 hyperintense with significant enhancement on MRI. Temporal bone is the most common affected part of skull base seen as destructive lesions with a soft tissue component.
– Spine: Vertebral bodies are affected with relative sparing of posterior elements. A typical vertebra plana appearance may be encountered with total collapse.
– Long bones: Ill-defined lytic lesions with/without cortical destruction are seen usually located at diaphysis or metaphysis. Periosteal reaction may be present. Extensive bone marrow and soft tissue signal changes on MRI may also be helpful in the diagnosis.
A 30-year-old female with right shoulder pain.
4 images of the right shoulder were obtained (axillar, Y-view, internal rotation, external rotation)
Right shoulder: There is a nondisplaced fracture involving the inferior aspect of the glenoid, with involvement of the articular surface. Glenohumeral joint shows normal alignment. Acromioclavicular joint is normal. No soft-tissue calcification. No fracture or dislocation
The most likely diagnosis is Hill-Sachs lesion
Hill-Sachs lesions are a posterolateral humeral head compression fracture. Typically occurs secondary to recurrent anterior shoulder dislocations. It is often associated with a Bankart lesion of the glenoid
These lesions are best seen following relocation of the joint. It appears as a sclerotic line running vertically from the top of the humeral head towards the shaft. A wedge defect may be evident in large lesions. The lesions are better appreciated on internal rotation views
57-year-old man with left iliac fossa pain:
What do you see?
* Infiltration/haziness around colon descendens with central fat density
* No or only moderate (secondary) inflammation of colonic wall
* Diverticulitis mimic, but self-limiting
A 43-year-old man with inflammation and lower abdominal pain:
What do you see?
* Inflammatory wall thickening of the sigmoid colon.
* Multiple diverticula, but one enlarged with thickened enhancing wall (arrow).
* Surrounding haziness of the mesosigmoid fat.
* Peritoneal accentuation
Typical image of diverticulitis, in a typical location with typical presentation
Look for signs of perforation or abscess formation