Case of the Week From 3/26/23
History: History of recent calcium scoring study. Scheduled for a cardiac CTA for chest pain.
What are the findings? Dense calcification in the left anterior descending artery and the right coronary artery.
What do you tell the ordering clinician? A cardiac CTA would most likely be severely limited due to beam hardening artifact from significant arterial calcification, making it difficult to exclude ischemia in the lumen. If there is continued clinical concern, consider angiography for for further characterization. (Some departments have cutoffs for calcium scores like greater than 500 or 1000 to help to make this decision)
Case of the Week From 3/19/23
History: 1st two films is a mass from 6 months ago that has been biopsied with pathology of a fibroadenoma. 2nd two films is the same mass today.
What are the findings? Significantly enlarging mass at the site of the previously biopsied fibroadenoma over six month.
What is the differential for this new change? Enlarging fibroadenoma, Phylloides tumor, Fibroadenoma with adjacent post surgical changes, Interval development of primary breast cancer within a fibroadenoma (very rare)
What would the next best step and why? Either biopsy or MRI. “Standard of care” is excisional biopsy but MRI can be considered for to confirm that rapid enlargement is not related to adjacent post intervention change/other etiology.
6 months ago
today
Case of the Week From 3/12/23
History: Thumb nodule.
What are the findings? Peripherally enhancing soft tissue with lower signal center abutting/hugging the ulnar aspect of the distal phalanx of the first digit. T2 bright signal centrally.
What is the differential diagnosis/most likely diagnosis? Given location and enhancement pattern, consider most likely a glomus tumor. Other skin tumors (i.e melanoma) and vascular tumors/soft tissue tumors are within the differential diagnosis.
Case of the Week From 3/5/23
History: Wrist pain.
What are the findings? Transverse non displaced fracture through the waist of the scaphoid
How is a CT scan be helpful based on the plain film findings? Increased sensitivity, can detect incongruence and loose bodies.
How common is this injury and what are the potential complications? 2-7 percent of all fractures, 60-70 percent of carpal fractures. Complications include avascular necrosis, delayed union, and scapholunate dissociation.
