Case of the Week From 5/29/22

History: Back pain in a runner.
What are the findings on the MRI? marrow edema at the pedicles/pars interarticularis
What is the role of performing a CT scan? To define if there is a subtle fracture/spondylolysis that MRI can miss. Subtle fractures are present in this case.
What is the final diagnosis and how does that change patient management? Spondylosis has a worse prognosis and is more likely to progress to a significant fracture with long term pain symptoms and longer healing times.

 

Case of the Week From 5/22/22

History: Swallowed a fish bone. Rule out foreign body.
What are the findings? Asymmetric calcification of the left styolohyoid ligament. Left parotid mass.
Is there a foreign body? No.
What is the differential diagnosis? Pleomorphic adenoma, Warthin tumor, squamous cell carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, other benign/malignant masses.

 

Case of the Week From 5/15/22

History: Foul smelling urine. CT images were performed 20 minutes after the original study.
What kind of test is this and how is it performed? Vaginogram. Injection of contrast performed through a balloon catheter tamponading the lumen to maintain pressure for possible fistula. Patient was subsequently sent to CT scan to look for a possible fistula.
What is the differential diagnosis/most likely diagnosis? Contrast was present in the bladder soon after administration of contrast on lateral view. Consider most likely vagino-vesicular fistula, less likely reflux of contrast into the bladder.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case of the Week From 5/8/22

History: Ankle mass.
What are the findings? Expansile  (especially at the anterior distal tibia) predominantly T2 bright lesion eccentric centered at the distal epiphysis and metaphysics of the tibial to the ankle joint. Multiple fluid fluid levels within the lesion. No findings to suggest aggressive destruction of the bone
What is the differential diagnosis? Anuerysmal bone cyst, giant cell tumor, fibrous dysplasia, chondroblastoma, telangiectatic osteosarcoma, chondroblastoma.
What should you do next? Recommend plain film for better assessment of the cortex and osseous structures.
What is the management of the most likely diagnosis? Anuersymal bone cyst- radical excision/curettage with histopathological verification  See radiopedia for more info!

 

 

Case of the Week From 5/1/22

History: Neck swelling and pain.
What are the findings? Left supraclavicular fascial swelling and edema adjacent to an enlarged “nodular” subclavian vein without occlusion.
What are some possible explanations for the diagnosis? Phlebitis of the subclavian vein with adjacent reactive inflammation or cellulitis/inflammation of the adjacent tissue with reactive changes at the subclavian vein.