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
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.
Severe complete unstable ankylosed spine fracture with cord compression and mielopathy
Ankylosed spine show specific patterns of fracture with: higher tendency to three column involvement, and increased frequency of neurologic complications.
72-year-old alcoholic patient with intractable dorsal pain and legs numbness and weakness.
What do you see?
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
Kümmel disease (osteonecrosis and collapse of the vertebral body)
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?
A 24-year-old female patient with headache. What do you see?
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)
48-year-old male patient, HIV (+); presented to emergency with headache, confusion, N/V.
What do you see?
T2 hyperintense lesions of left caudate nucleus, left putaminal and right dentate nucleus , with perilesional edema.
Small corticomedullary T2 hyperintense lesions with faint enhancement.
Caudate and putaminal lesions demonstrates faint peripheric contrast enhancement whereas cerebeller lesion has strong peripheric and central nodular enhancement.
Caudate and cerebellar lesion have tiny microhemorrhages on SWI, a clue for diagnosis.
· Most common opportunistic CNS infection and most common cause of a mass lesion in AIDS
· Basal ganglia, thalamus, corticomedullary junction and cerebellum frequently involved
· Microhemorrhages can be seen on SWI, lesions may have ring or nodular enhancement
· Major ddx is lymphoma:
– Lymphoma is usually solitary whereas solitary lesions are uncommon in toxoplasmosis.
– Microhemorrhages are uncommon in lymphoma
27-year-old patient with neurofibromatosis-type 1 (NF-1). Bone lesions found on PET-CT
Multiple bilateral multiloculated eccentric metaphyseal lucent lesions with thin sclerotic rim
Multiple non-ossifying fibromas in a patient with NF-1
Very common benign lesion in young adults. Tend to heal or involute. Vast majority asymptomatic. Large lesions may be painful or weaken the cortical predisposing to pathological fracture (rare). Multiple in NF-1