Case of the Week From 1/28/24
History: History of epididymitis and orchitis. Rule out scrotal neoplasm. (1st image-T1 post-contrast, 2nd image- T1, 3rd image T2)
What are the findings? Intratesticular T1 and T2 bright circumscribed rounded lesions. Peripheral scrotal enhancement and inflammation
What is the most likely diagnosis? Intratesticular hematomas. Hemorrhagic neoplasm is less likely but within the differential.
What is the recommendation based on the study and symptoms? Short-term follow-up ultrasound, 1-3 months, to check for interval resolution of the hematoma.
Case of the Week From 1/21/24
History: Leg lump.
What are the findings? Osseous corticated mass extending off of the femur, likely with extension of the medullary cavity. No periosteal reaction, fracture, or acute complication.
What is the most likely diagnosis? Large femoral osteochondroma.
What is the recommendation based on the study and symptoms? Depending on symptoms/pain, can recommend MRI to determine size and thickness of the cartilaginous cap. If thickened, consider malignant transformation.
Case of the Week From 1/14/24
History: Headache. Rule out stroke
What are the findings? air within the parapharyngeal spaces/fat
What is the differential diagnosis? Pneumomediastinum with dissection into the neck. ? esophageal tear from wrenching, neck injury
What is the recommendation based on the study? Let the ER know. Consider esophagram depending on symptoms.
Case of the Week From 1/7/24
History: Back pain. Fever. First two images from a Gallium SPECT-CT scan 2 weeks afterward. Second two images from a contrast enhanced MRI from today.
What are the findings? Gallium avidity near the right L5-S1 neural foramen and facet joint. Enhancing lesion at the right central spinal canal at the L5-S1 level.
What is strange about the gallium scan compared to the MRI lumbar spine? The location is different from the enhancing lesion at the posterior right spinal canal at the right L5-S1 level vs. the right . This may mean that the infection has spread to the adjacent facet joint. And that the collection may have resolved or ruptured.
What is the recommendation based on the two studies? Recommendation to treat as osteomyelitis/epidural abscess!
