Case of the Week From 8/27/23
History: Back pain.
What are the key findings and diagnosis? Mildly displaced spinal process fractures at the cervicothoracic junction at the edge of the film.
What can be done for confirmation and for additional findings? CT thoracic spine can be performed for confirmation.
Case of the Week From 8/20/23
History: Leg pain after injury
What are the findings on the plain film and what most likely explains the patient’s symptoms? Multiple eccentric lytic lesions within the proximal and distal tibia and fibula. Each has well defined sclerotic borders and has fairly small zone of transition. The lesions are eccentric and situated at the metaphases. And the proximal fibula lesion has cortical disruption with perinatal reaction, suggesting a pathologic fracture.
What is the differential diagnosis? Multiple nonossifying fibromas with pathologic fracture at the proximal fibula. Fibrous dysplasia/Fibrous tumors. Giant cell tumor is unlikely because of well defined sclerotic borders and multiplicity of lesions,
Case of the Week From 8/13/23
History: Status post injury. Pain and locking.
What are the findings on the plain film? Subtle curvilinear calcification posterior and inferior to the patella.
Do the MRI findings correspond to the plain film findings and what are they? Yes. Mildly inferiorly displaced chondral fragment from the the patella corresponds to the plain findings.
What is the main cause for the patient’s symptoms? Patellar osteochondral injury- grade 5
What are the treatment options? fixation, chondroplasty, microfracture, autologous matrix-induced chondrogenesis, autograft transplants, allograft transplants and autologous chondrocyte implantation (see reference)
Case of the Week From 8/6/23
History: Right upper quadrant pain. 1st image: From 1 year ago. 2nd image: From today.
Describe the findings: Interval development of a new hyper dense enlarging mass lesion at the site of previous slightly complex cystic density lesion at the upper pole of the right kidney. New mild adjacent stranding.
What is the most likely cause for the patient symptoms? Bleeding into a complex cyst. Differential can cause typical bleed into a cyst or bleed into a cystic angiomyolipoma or renal cell carcinoma.
What should be done next and why? Followup CT scan or MRI to confirm resolution and to exclude possibility of a bleeding mass.
