Case of the Week From 2/25/24
History: Lung nodules. Breast cancer.
What are the findings? MRI with right adrenal nodule with signal drop out on T1 out of phase imaging compared to in-phase imaging. Right adrenal nodule with mean hounsfield units of greater than 60 after contrast administration.
What is the diagnosis? Adrenal adenoma.
Which is the better test to make this diagnosis and why? CT was not performed as a diagnostic study for adenoma. (needs washout imaging and should be > then 50 percent washout imaging).
Case of the Week From 2/18/24
History: Ankle soft tissue swelling
What are the findings? Circumscribed intraarticular tibiotalar joint T1 dark and heterogenous slightly bright T2 oval lesions with adjacent fluid. Does not follow fat signal.
What is the differential diagnosis? Complex synovial cyst, PVNS, synovial osteochondromatosis, synovial cell sarcoma.
What is the next step? Recommend repeat imaging of the ankle with gradient echo sequence imaging and intravenous contrast.
Case of the Week From 2/11/24
History: History of kidney infections and flank pain..
What are the findings? Good perfusion. Atrophic right kidney. Normal left renal function and excretion. Equivocal shallow right clearance curve.
What is the most likely diagnosis? Borderline normal clearance of the right kidney, likely not related to mechanical obstruction. Normal left renal clearance.
What is the clinical significance of the findings? Atrophy, may be related to congenital abnormality or chronic changes. Decreased renal function can make it harder to evaluate for clearance due to lack of uptake..
Case of the Week From 2/4/24
History: Left neck lump.
What are the findings? Rim enhancing lesions within the level II cervical chain with central necrosis/fluid density. Loss of the flow within the internal jugular vein above the level of the lesions.
What is the most likely diagnosis? Either necrotic lymph nodes from malignancy or infection. Possible occlusion of the left internal jugular vein.
What is the clinical significance of the findings? Lesion needs to be biopsied. Concern needed to make sure clot is not propagated.
