Case of the Week
Cases of the Week By Month (For 2019-2020)
This Week’s Case of the week From 12/30/18
History: Abdominal pain.
What are the findings? Multiple left renal cysts, diffuse colonic low-density wall thickening with thickened folds and mild adjacent stranding from the proximal transverse colon to the proximal rectum/distal sigmoid, dominant left-sided renal cyst and multiple parapelvic cysts, moderately enlarged prostate gland
What is the differential diagnosis for the findings most likely to cause the patient’s symptoms? C. Dificile, Inflammatory colitis, Ischemia
What is the most likely of these diagnoses and why? C. dificile colitis because of a low-density boggy colon with diffuse segmental inflammatory change not extending to the distal rectum.
Answers To Case of the Week From 11/4/18
Answers To Case of the Week From 10/27/18
12 hours ago
Answers To Case of the Week From 10/6/18
Answers To Case of the Week From 9/30/18:
Answers To Case of the Week From 9/16/18
Answers To Case of the Week From 9/9/18
Answers To Case of the Week From 9/2/18
Answers To Case of the Week From 8/26/18
History: Abdominal pain.
Answers To Case of the Week From 8/19/18
History: Abdominal pain.
What are the findings? Gastric sleeve/post-bariatric surgery. Right anterior abdominal wall collection with adjacent stranding and inflammatory change.
What is the most likely cause for the main diagnosis? Collection- most likely postoperative hematoma or infected hematoma/abscess. Likely related to prior bariatric surgery.
How would you manage this case? Consult with surgery- likely ultrasound guided abscess drainage
Answers To Case of the Week From 8/12/18
History: Shin pain.
What are the findings? Edema in the bone and subcutaneous edema on STIR sequence with adjacent anterior tibial cortical thickening. On T1, enhancement of the subcutaneous soft tissues and enhancement of the tibial marrow adjacent to the swelling.
Give the most likely diagnosis: Anterior shin cellulitis with adjacent tibial osteomyelitis
Answers To Case of the Week From 8/5/18:
History: Pelvic pain.
What are the findings? Gallium scan and SPECT shows increased activity at the right sacroiliac joint. MRI STIR sequence shows marrow edema at the right sacroiliac joint.
Give the most likely diagnosis? sacroiliitis at the right sacroiliac joint. Differential also includes septic joint (less likely)
Answers To Case of the Week From 7/29/18:
History: Abdominal Pain.
Answers To Case of the Week From 7/15/18:
History: None provided.
Type of Study: Cystogram
Diagnoses: Cystogram showing left-sided vesicoureteral reflux and a vesicoenteric fistula to the sigmoid colon.
Answers To Case of the Week From 7/8/18:
Answers To Case Of The Week From 6/24/18
What are the findings? Round circumscribed nodule just lateral to the left optic nerve within the intraconal space.
What are the findings and the diagnosis? Large gap in distal Achilles tendon, Achilles Tendon Rupture
What are the most important findings to tell the clinician? The size of the gap and the location of the tendon with respect to the calcaneal insertion
Answers To Case of the Week From 4/15/18:
History: Status post trauma. Neck Pain.
What are the findings and likely diagnosis? Dorsally displaced dens fracture/ Type II dens fracture
Answers to Case of the Week From 4/8/18
History: Hip pain
What are the findings and likely diagnosis? Right femoral head double line sign with adjacent marrow edema, subacute avascular necrosis of the hip
History: Abdominal pain.
What are the findings and likely diagnoses? Dilated left renal collecting system and ureter, likely related to herniation into inguinal scale. (More Challenging Diagnosis) Abrupt caliber change at the distal common bile duct. ? etiology
Answers to Case of the Week From 3/25/18
History: Arm pain.
What is the differential diagnosis? Fibrous dysplasia, Aneurysmal bone cyst, Giant cell tumor
Answers to Case of the Week From 3/18/18
History: Neck pain. History of prior surgery.
What is the most likely diagnosis? Interval loosening of the hardware at the C3 pedicle.
1st video – 2 years ago,
2nd video- today
Answers to Case of the Week From 3/11/18
History: Back pain.
What is the most likely diagnosis? Interval Development of Pagetoid changes at L4 with picture frame vertebral body and suggestion of trabecular thickening.
today 2 years ago
Answers to Case of the Week From 3/4/18
What is the most likely diagnosis? Early embryonic demise
What else do you need to do? Confirm with realtime ultrasound and/or video because of potential errors with M-mode. Call the doctor.
Answers to Case of the Week From 2/25/18
History: Head swelling/lump.
What is the diagnosis? Pott’s Puffy Tumor
Answers to Case of the Week From 2/18/18
History: Jaw pain.
What is the diagnosis? Sialoadenitis
Answers to Case of the Week From 2/11/18:
History: Right Lower Quadrant Pain
What are the diagnoses? Right-sided delayed nephrogram with findings suggestive of a distal ureteral stone. Multiple appendicoliths within a borderline sized appendix.
What would you tell the referring doctor? Symptoms are most likely related to a distal urinary tract stone with obstruction. Appendicoliths and borderline sized appendix are likely chronic, possibly related to prior inflammation. Recommend clinical follow-up with a surgeon.
Answers to Case of the Week From 2/4/18
What is the diagnosis? ALS
Answers to Case of the Week From 1/28/18
History: Prostate Cancer
What do you want to do next? Bone SPECT
What is the differential diagnosis? Degenerative disease, lumbar compression fracture, metastatic disease, and overlying contamination (the ultimate diagnosis)
Answers to Case of the Week From 1/21/18
History: Chest Pain. Shortness of Breath.
What are the diagnoses? Calcific pericarditis and right-sided pleural effusion with adjacent atelectasis or pneumonia.
Answers to Case of the Week From 1/14/18
History: No history.
What kind of scan is this? Tc-99m MDP Bone SPECT
What is the most likely diagnosis? Left rib fractures. Left costovertebral angle post-traumatic vs. degenerative change.
Answers to Case of the Week From 1/7/18
History: Reflux. Difficulty eating solids.
What is the most likely diagnosis? Distal esophageal cancer
What is the differential? Distal esophageal cancer, Achalasia
What would you recommend to do next? Endoscopy
Answers to Case of the Week From 12/31/17
History: Right-sided facial pain.
What is the most likely diagnosis? Fibrous dysplasia of the right skull base with expansile ground glass lesion causing narrowing of several right-sided skull base neural foramina
What is the differential? Fibrous dysplasia, less likely metastatic disease given lack of erosive changes.
What would you recommend to do next? Neurosurgical consult
Answers to Case of the Week From 12/24/17
History: Call back for asymmetric density.
What is the diagnosis? Overlapping normal breast parenchyma
What techniques are used? Standard CC view, Digital Tomography CC view, Spot Compression Digital Tomography CC view
What is the point of showing this case? Spot compression imaging can be important even when a patient has had a prior mammographic tomogram. Sometimes additional compression can spread out and isolate the normal tissue that may be equivocal on standard digital tomography. In this instance, we performed a spot compression of a tomogram.
Answers to Case of the Week From 12/17/17
What is the diagnosis? Tc99m Mag-3 study showing right-sided mechanical urinary tract obstruction with slightly increased right renal cortical retention/mild component of renal tubular dysfunction.
Answers to Case of the Week From 12/10/17
History: Wrist pain. Recent injury.
What is the diagnosis? Tear of the dorsal radioulnar ligament of the TFCC.
Answers to Case of the Week From 12/3/17
History: Abdominal pain. R/O Abscess
What are the three imaging modalities? Contrast enhanced CT scan, Contrast enhanced T1 Weighted MR, Tc99m Tagged Red Blood Cell Scan
How would you manage this case? Given that there is a mildly enhancing mass inferior to the spleen without uptake on red blood cell imaging (not splenosis), next step would be biopsy to determine if it is neoplasm, infectious, or inflammatory.
Answers to Case of the Week From 11/26/17
History: Shortness of breath
What are the two imaging modalities? V/Q SPECT and CT scan
What is your final diagnosis? No findings to suggest PE/low probability with nonsegmental defect corresponding to a right upper lobe mass
Answers to Case of the Week From 11/19/17
History: Toe Pain
What is the most likely diagnosis? Osteomyelitis of the 1st digit
What is the best test for confirming the diagnosis and why? Tagged white blood cell scan because the resolution of the toes tends to be poor on MRI.
1 year ago Today
Answers to Case of the Week From 11/12/17
History: Rectal Cancer
What is the MRI sequence? High Res T2 weighted image perpendicular to the rectal axis.
What is most important to tell the surgeon based on the MRI findings? Ill definition of the rectal wall consistent with a T3 tumor.
Answers to Case of the Week From 11/5/17
History: Breast cancer. Left pubic symphysis lesion.
What is the most likely diagnosis? How would you manage this patient?
Probably a benign pubic symphyseal subchondral cyst related to degenerative change with slight growth over 6 years.
How would you manage this patient?
Followup CT scan or MRI to check for continued stability.
6 years ago
Answers to Case of the Week From 10/29/17
History: Difficulty Swallowing.
What are the studies?
CT scans, Ultrasound, Iodine-123 scan
What is the most likely diagnosis?
Ectopic thyroid tissue.
Answers to Case of the Week From 10/22/17
What are the studies?
Tagged Tc99m-RBC scan and CT scan
What is the most likely diagnosis
Hyperemia likely related infectious or inflammatory colitis (Activity in the right upper quadrant is stationary)
Answer to Case of the Week From 10/15/17
1. What are the studies?
- Pyp scans 2. CT scan without contrast
2. What is the diagnosis?
transthyretin-related cardiac amyloidosis
Answer to Case of the Week From 10/8/17
1. What are the studies?
- Gallium Scan 2. Oral Sulfur Colloid 3. CT scan of the chest at the level of the shoulders. 4. Right shoulder plain film
2. What is the presumptive diagnosis? What is the management?
Given a positive gallium scan at the right shoulder with negative right shoulder CT scan and negative right shoulder series with a history of shoulder pain consider early septic joint/osteomyelitis of the right shoulder.
3. What is the management?
Recommend MRI for confirmation of diagnosis if lower clinical suspicion. Alternatively, can tap the joint if there is continued high clinical suspicion.
Answer to Case of the Week From 10/1/17
Findings: Edema within the hamstring musculature consistent with a muscle strain/partial muscle tear
Answer to Case of the Week From 9/24/17
Scan type: Indium 111 labeled octreotide scan
Findings: Left hepatic lobe lesion on first two images (6 months ago) is more intense on the next two images (today) and corresponds to a hepatic lesion on CT scan
Final Diagnosis: Interval progression of carcinoid liver metastasis.
Answer to Case of the Week From 9/17/17
First two images on the left- 3 months ago, round oil cyst with almost imperceptible walls at the lower inner quadrant
Two images on the right- New thickening and irregularity of the walls of the oil cyst- likely an infected oil cyst.
Management- Can followup in 3 months to check for interval resolution. BIRADS-3
Answer to Case of the Week From 9/10/17
Findings: Bright T2 dark signal instead of the normal T2 dark signal near the plantar fasica insertion site at the plantar calcaneus with thickening. Abnormal thickening on T1 weighted imaging.
Diagnosis: Full thickness plantar fascia tear
Answer to Case of the Week From 9/3/17
Findings: Meniscal chondrocalcinosis with relatively increased osteophytosis and joint space narrowing at the patellofemoral joint.
Diagnosis: Most likely CPPD (Calcium Pyrophosphate Deposition Disease). Also, consider atypical osteoarthritis.
Answer to Case of the Week From 8/27/17
Radiopharmaceutical: Gallium-68 Dotatate (Similar mechanism of action to octreotide)
Diagnosis: Normal variant uptake in the pituitary. Unremarkable Ga-68 Dotatate PET-CT Scan
Answer to Case of the Week From 8/20/17
Enhancing infiltrative hepatocellular carcinoma (HCC). In this case, there was abnormal arterial enhancement at the periphery of the liver.
Gallium is often warm or hot at the site of HCC. In this case, it was of similar uptake compared to the remainder of the liver.
Answer to Case of the Week From 8/13/17
(Right Image) New Right Iliacus Retroperitoneal Hemorrhage
Answer to Case of the Week From 8/6/17
Leftmost study: CT scan with subtle sclerotic lesion at the left ischial tuberosity
2nd to left study: Bone scan showing a cortically active left ischial tuberosity lesion likely corresponding to the CT scan findings
Three right most studies: Axumin PET-CT showing left inguinal adenopathy and no Axumin active lesion corresponding to the sclerotic lesion on PET
Even though the lesion on Axumin lesion is not active, it is still highly suspicious for a bone metastasis give the positivity on bone scan. Axumin is not reliable as a predictor of bone metastases and sclerotic bone lesions if negative (less active than blood pool). These lesions on if not active on Axumin and seen on CT scan should be treated with caution and worked up further!!!
Answer to Case of the Week From 7/29/17
Right adnexal dermoid. Pelvic kidney.
Answer to Case of the Week From 7/22/17
Narrowing/stricture from duodenitis/duodenal ulcer
Answer to Case of the Week From 7/15/17
Non displaced glenoid fracture. Here is the film showed previously and the MRI confirmation.
Answer to Case of the Week From 7/8/17:
Right inguinal hernia with entrapped small bowel causing small bowel obstruction