Case of the Week From 7/30/23
History: Status post pinky injury playing basketball. Pain.
Describe the findings and the affected structures: Edema replacing the normal low signal of the ulnar and radial collateral ligaments at the fifth PIP joint. Persistent flexion at the fifth PIP joint. Partial discontinuity/thinning of the extensor tendon at the level of the proximal phalanx and the PIP joint with adjacent fluid.
What are the diagnoses? radial and ulnar ligamentous tears at the PIP joint. Partial tear/avulsion of the extensor tendon at the distal portion of the 5th proximal phalanx.
What is the treatment? Depends on the stability of the PIP joint upon physical examination. Splinting if more stable. Surgical repair if unstable.
Case of the Week From 7/23/23
History: High risk calcium scoring study. Elevated troponin.
Describe the findings: Significant calcium in the left anterior descending, left circumflex, and right coronary arteries. And, most importantly, portal venous gas within the liver!!!!
What are your next recommendations and why? Call a surgical consult. Bowel ischemia can be related to portal venous gas.
Case of the Week From 7/16/23
History: Back pain.
Describe the findings: Infiltrative enhancing nodules within the left ureter and within the bladder. Accompanying delayed left renal uptake and hydronephrosis.
What is the diagnosis that is likely causing the patient’s symptoms? Transitional cell carcinoma of the left renal collecting system and bladder with accompanying obstruction.
What is the other interesting incidental diagnosis? Anomalous right pulmonary vein drainage into the IVC. Scimitar syndrome.
Case of the Week From 7/9/23
History: Patellar tendon pain.
Describe the findings: T2 bright lateral facet femoral intercondylar notch defect at the cartilage and subchondral bone.
What is the most likely cause for the symptoms? Osteochondral injury of the lateral facet of the intercondylar notch.
What are the treatment options? wide ranging depending on symptoms: NSAIDS, glucosamine, debridement, arthroplasty, osteochondral transfers, cell transplantation
Case of the Week From 7/2/23
History: Hip pain.
Which image gives the best clue to the problem and why? The first image (AP image) to the left shows that the right femoral head is more laterally deviated compared to the left femoral head. Can be seen with congenital hip dysplasia.
Should you pursue a hip ultrasound? Why or why not? No. Because the femoral head has already ossified and will prevent visualization of the hip on ultrasound.
What would you recommend to do next? Clinical evaluation and assessment by orthopedics. Closed reduction may be necessary if the orthopedist finds that the abnormality is clinically revelant.
