Case of the Week From 12/31/23

History: Abdominal pain. Weight loss.
What are the findings? Unilocular cystic mass abutting the tail of the pancreas  and the left kidney with some perpheral calcification.
What is most likely origin of the cystic mass? Most likely comes from the pancreatic tail due to “claw sign”.
What is the differential for the cystic mass? Pancreatic cyst, pancreatic neoplasm such as cystadenoma. IPNM, cystic neuroendocrine tumor, or pancreatic pseudocyst. Renal cystic lesion is less likely.

Case of the Week From 12/24/23

History: Severe cramping with symptoms that just started to improve.
What are the findings on the previous study? Significantly dilated small bowel loops with air fluid levels and contrast. ? Small bowel obstruction.
What has changed? Decreased dilatation of  the small bowel. New extraluminal collection at the left paracolic gutter with a stream of oral contrast. Acute bowel peforation!
Why might the patient feel better all of a sudden? Acute bowel perforation can relieve the pressure in the bowel and cause sudden improvement in symptoms (the calm before the storm!). Afterward a peritonitis will subsequently develop, however!

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Case of the Week From 12/17/23

History: Status post knee injury with pain.
What are the findings? Marrow edema of the medial patellar pole and the lateral femoral condyle, likely related bone bruising/contusions. Fluid adjacent to the medial retinaculum of the patella with some loss of signal, suggesting a partial tear.
What is the most likely mechanism of injury? Transient dislocation of the patella from twisting of the knee.
How would these injuries be treated? Immobilization and physical therapy. If the retinaculum tears is severe, surgical repair can be considered.

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Case of the Week From 12/10/23

History: Right upper quadrant abdominal pain.
What are the findings? Distended gallbladder with sludge on ultrasound and wall thickening on both MRI and ultrasound
What is the most likely diagnosis? Cholecystitis.
Is there a role for any other test and why? Depends on the clinical situation. If there is a sonographic Murphy’s sign and/or high clinical suspicion, patient can go directly to surgery. If neither of these conditions exist, the next step would be a physiologic test/hepatobiliary scan to exclude cystic duct obstruction.

Case of the Week From 12/3/23

History: Pain with walking
What are the findings? T1 dark and T2 moderately bright dumbbell shaped lesion between the 2nd and third metatarsal heads on coronal views.
What is the differential diagnosis? Morton neurons or impingement at the intermetarsal soft tissues.
How is it usually treated? arch supports, foot pads, corticosteroid injections, strength exercises, wide toe shoes, or least often surgery.