Random Cases Flashcards
What is shown on this pelvic radiograph, and what are the possible causes?
Bilateral AVN
What is this condition?
ACROMEGALY
Fx:
- Enlarged sella turcica
- Prognathic jaw
- Calvarial thickening
- Enlargement of the sinuses
- Hypertrophied terminal phallanges (spade like - see image below)
- Increased heel pad thickness
On this CXR, where is this mass and
what is the DDx?
Anterior mediastinal mass
- Teratoma (as in this case)
Elbow radiograph - Que?
Osteochondral Defect
MRI classification of OCD:
- Marrow edema (stable).
- Articular cartilage is breached. Low-signal rim surrounding fragment indicates fibrous attachment(stable).
- Pockets of fluid around undetached and undisplaced osteochondral fragment (unstable).
- Displaced osteochondral fragment (unstable).
Management:
Stage 1 & 2: Conservative treatment (low-intensity physical rehabilitation) is recommended for stable (stages I and II) lesions.
If symptoms worsen or fail to improve or crepitus (suggesting detachment Stages 3 & 4) develops, then:
- Arthroscopy is recommended to evaluate stability of the lesion.
- Depending on findings at arthroscopy, a loose body may be removed, a fragment may be excised, cartilage may be debrided, or lesion may be drilled to promote revascularization.
Limb Radiograph
Que ?
Fibrous Dysplasia
Fx:
- Lucent lesion in the diaphysis or metaphysis
- Endosteal scalloping
- +/- bone expansion
- No periosteal reaction.
- Ground-glass appearance
- Remodeling - Shepherd’s crook deformity
- In the chest the ribs can be so expanded they mimic pleural lesions (see image below)
This AP knee in a young patient demonstrates what?
Widened Intercondylar notch
This patient has Still’s disease
What is going on in this cxr?
Pneumoconiosis and PMF
What does this axial shoulder MRI show?
Hill-Sachs Lesion
What does this lateral C-spine show?
Posterior scalloping the DDx includes
- NF (this case)
What is the DDx for this CXR?
Bilateral Nodular Shadowing
IVU image Ureter Abnormality
DDx?
Retrocaval Ureter
The causes of Medial Deviation of the Ureters include:
- Retroperitoneal fibrosis
- Retrocaval Ureter (just the right)
- Normal variant - 15%
- Pelvic Lipomatosis
- Iatrogenic - post AP resection
This CXR demonstrates what?
PDA:
Shoulder Radiograph
What is this and its cause?
Charcot Shoulder Joint
Image fx:
- Mnemonic : 6 Ds 1
- Dense bones (subchondral sclerosis)
- Disorganisation
- Destruction of articular cartilage
- Deformity
- Debris (loose bodies)
- Dislocation
Causes:
- Shoulder - syringomyelia, spinal tumor; polio
- Elbows and wrists – syringomyelia, polio
- Hips – tertiary syphilis, diabetes
- Knees – tertiary syphilis (more bone production), diabetes (less bone production)
- Feet – diabetes, congenital insensitivity to pain, chronic alcoholism
- Other causes
- Leprosy
- Alcoholism
This is alpha-1-antitrypsin.
What are the features?
Features of A1-ATP
Male patient with pain in his elbow
Synovial Osteochondramatosis
DDx:
- Synovial chondrosarcoma
- Pigmented villonodular synovitis
Fx:
- Metaplasia of synovial membrane resulting formation of cartilaginous and osseous bodies
- May occasionally embed into synovium and not be free-floating in joint, requiring complete synovectomy for symptomatic relief
- Usually monoarticular
- Occurs intra-articular, especially in large joints.
- Knee>shoulder>elbow>hip
- May be associated with erosions or joint destruction
- Radiographic findings: multiple round bodies of similar size and variable calcification, conglomerate mass or free-floating. However, 30% do not calcify and may only show erosions.
- Malignant transformation is extremely rare. No reliable distinguishing feature on imaging.
- The PD MRI demonstrates low-signal-intensity calcified nodules located deep to the infrapatellar bursa.
Paeds CXR: Que?
RACHITIC ROSARY RIBS:
Refers to expansion of the anterior rib ends at the costochondral junctions.
Aetiology:
- Rickets (commonest)
- Scury
What is the likely diagnosis for this spine radiograph?
Ochronosis aka Alkaptonuria
- Usu AR inheritance
- There is an absence of homogentisic acid oxidase leading to an excess of homogentisic acid.
AXIAL Skeleton Fx:
- Osteoporosis
- Intervertebral disc Ca++
- Disc space narrowing
- Marginal osteophytes and end-plate narrowing
- Chondrocalcinosis and joint space narrowing of the symphysis pubis
Appendicular skeleton:
- Large Joints:
- Joint space narrowing
- sclerosis
- articular collapse / fragmentation
- intra-artic. loose bodies
- Calcification of bursae + tendons
Extraskeletal:
- Cardiovasc:
- Ca++ of aortic / mitral valves
- Atherosclerosis
- Genito-urinary:
- Renal calculi
- nephrocalcinosis
- prostatic enlargement with calculi
Barium Meal: What is going on in the Antrum?
Gastric Ca
DDx for stomach narrowing include:
Neoplastic causes:
- Gastric adenoca - leads to linitus plastica
- Lymphoma - usu antral narrowing extending to the duodenum (see CT below)
- Mets - Linitus plastica from breast mets
Inflammatory:
- Helicobacter pylori gastritis
- TB (rare)
- Crohn (rare)
Iatrogenic:
- Radiotherapy
- Corrosive Ingestion
What condition is being demonstrated on this skull radiograph?
Acromegaly
Skull Fx:
- Enlarged Sella due to pituitary adenoma
- Enlarged paranasal sinuses
- Thickening of the skull
- Prognathism
Knee MRI-Young women in RTA
Morel-Lavallee Lesion
- Morel-Lavallee lesion is the result of a closed degloving injury involving the separation of skin and subcutaneous fat from underlying fascia.
- It is caused by a blunt shearing force applied across the skin surface
- It presents as a T1 hypo intense, T2 hyper intense fluid collection within the subcutaneous fat with a surrounding pseudocapsule.
- This lesion most commonly occurs in the hip, but also occurs in the lower back, buttocks, greater trochanter, lateral thigh, and prepatellar space.
- Treatment consists of conservative therapy versus aspiration versus open debridement, and almost all patients completely heal in the long run.
DDx Include:
- Prepatellar bursitis
- Hematoma
- Fat necrosis
- Synovial sarcoma
- Malignant fibrous histiocytoma
Man feeling unwell with cough
Bulging Fissure
DDx:
- Necrotising Pneumonia / abundant exudates: Klebsiella, Staph aureus, Klebsiella, Strep pyogenes and Strep pneumonia. - This case
- Abscess: Klebsiella and Staph Aureus
- Carcinoma of the bronchus.
The abnormality on this shoulder MRI is?
Bankart Lesion
A Bankart # involves the inferior glenoid
Ankle Radiograph:
What is going on here?
AVN of the Talus
Aetiology:
- Alcohol
- Steroids
- Sickle cell
- Trauma
- Pregnancy
- Radiotherapy
- Pancreatitis
Staging:
- X-ray : normal or minor osteopaenia / MRI : oedema
- X-ray : mixed osteopaena &/or sclerosis; MRI : geographic defect
- X-ray : crescent sign & eventual cortical collapse; MRI : same as Xray
- X-ray : end stage with evidence of secondary degenerative change; MRI : same as Xray
