After fall from about 1 meter high
Felt a snap in his knee
Instability
Deep lateral notch (sulcus) sign on lateral projection
Suprapatellar effusion
MRI of the knee, due to high index of suspicion for ACL tear
Patient had additional abnormalities of the knee not shown.
With trauma
Painful elbow after a fall from height
Supination and pronation painful
The case represents a classic capitellum fracture, with a mildly displaced fragment on the lateral projection, which can easily be missed if one is not familiar with the double-arc sign.
45-year-old female with forefoot pain:
D3/D4 intermetatarsal space
T1- and T2-hypointense soft tissue mass located in D3/D4 intermetatarsal space – Morton neuroma.
Morton neuroma is a result of a compressive neuropathy of the forefoot interdigital nerve. The most common location for interdigital neuromas are between the 3rd and 4th metatarsal heads. Most patients with Morton neuroma have a good recovery with non-surgical treatment.
Munir U, Tafti D, Morgan S. Morton Neuroma. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470249/
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
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
Young male patent:
– Presented with elbow pain post-fall of bicycle
Olecranon process fracture
Elevated posterior fat pad projecting posterior to the distal humerus indicative of the presence of an intracapsular effusion in the elbow
