Case of the Week From 10/29/23

History: Migraines.
What are the findings on today’s MRI? Enlarged posterior pituitary T1 bright spot. No significant differential enhancement.
What is the most likely differential? Rathke’s cleft or pars intermedia cyst. Less likely hemorrhagic pituitary adenoma.
What would you recommend to do next? Correlate with endocrinological testing.

Case of the Week From 10/22/23

History: Headache. Last CT scan is from 5 years earlier.
What are the findings on today’s CT scan? Hyperdensities at the left cerebellar parenchyma that were not there five years ago.
Based on today’s CT scan finding what is the most likely diagnosis? New mineralization of the left cerebellar white matter, given lack of adjacent edema, glosis, or mass effect.
How does the MRI clarify the final diagnosis? What would you recommend next? Susceptibility artifact is confirmed without any edema or restricted diffusion. These findings suggest old blood products from old intraparenchymal hemorrhage or vascular malformation. No further workup necessary.

5 years ago

Case of the Week From 10/15/23

History: Hip pain.
What are the findings? Significant bilateral acetabular protrusio with bilateral synovial proliferation.
What is the differential diagnosis? osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthropathy, paget’s disease, osteomalacia,
What should be the next step in the workup and why? Correlate with inflammatory arthritis blood work panel and history.

Case of the Week From 10/8/23

History: 18 year old man with thumb pain.
What are the findings? Prominent well circumscribed subchondral lytic lesion with small zone of transition near the 1st MTP joint in a an 18 year old.
What is the differential diagnosis? Subchondral cysts from Juvenile Rheumatoid Arthritis. Or consider possibility of atypical enchondromas.
What should be the next step in the workup and why? Correlate with lab work (i.e. ESR, rheumatoid factor etc.). Noninvasive way to determine if the etiology is related to active inflammation, JRA, etc. If labs are equivocal, CT scan may be helpful to further delineate internal matrix for the subchondral lesions for possibility of enchondromas with calcified matrix.

Case of the Week From 10/1/23

History: Left hip pain.
What are the findings? Interval development of diffuse marrow edema at the proximal femur and the left acetabulum. A suggestion of some erosive changes and the left femoral head
What is the differential diagnosis? Septic arthritis, inflammatory arthritis, early avascular necrosis, transient osteoporosis of the hip, trauma/contusions.
What is the most critical consideration? Septic arthritis. Needs to be treated with antibiotics STAT!

One year ago

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