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Rads•MD Radiology

Interesting radiology cases for those involved or curious about the art of image-driven diagnosis in medicine.

Georgetown School of Medicine
Georgetown University Medical Center
Lahey Clinic Medical Center
John Hopkins Hospital

$ER MVA "can't feel feet"CT Lumbar Spine w/o contrast.F: Comminuted compression fracture superior endplate L1. 40% loss v...$

01/22/2021

ER MVA "can't feel feet"

CT Lumbar Spine w/o contrast.
F:
Comminuted compression fracture superior endplate L1.
40% loss vertebral body height.
Disruption of posterior vertebral body,
1 cm retropulsion of fragment into central canal
Marked central canal narrowing at least 90%.
Marked compression central cord.
No involvement of posterior elements.
I: Burst fracture L1.
Rec: MRI lumbar spine

Burst Fracture.
--compression fracture with disruption of posterior vertebral body cortex and with retropulsion into spinal canal.
--most commonly occur at L1.
--result from high-energy axial load analogous to Jefferson fracture of C1

01/13/2021

Gastric Emphysema

ER ill, epigastric pain, n/v.
CT AP w/o contrast.
F: gastric wall thickening, nondependent intramural foci of gas. portal venous gas.
I: emphysematous gastritis.
Ddx: ischemia.

Dx. emphysematous gastritis at autopsy.

Emphysematous gastritis:
Rare. Severe gastritis secondary to mucosal disruption and gas-forming bacterial invasion characterized by air in wall of stomach

Prognosis:
60-80% fatal

$Snuffbox Pain.ER fall, pain swelling around distal radius.XR WristF: Acute nondisplaced fracture middle third of scaphoi...$

01/04/2021

Snuffbox Pain.

ER fall, pain swelling around distal radius.
XR Wrist
F: Acute nondisplaced fracture middle third of scaphoid. No articular involvement. No joint dislocation. Scapholunate interval normal. No other fractures. Soft tissue welling. DJD.
I: Scaphoid fracture.

Scaphoid waist fracture is the most common location in adults.

12/25/2020

Incidental Findings.

Adrenal calcifications in otherwise healthy asymptomatic patient is usually the result of previous hemorrhage or tuberculosis.

12/16/2020

When lesions are missed.

4/2018. Pt p/w freq, hematuria, dysuria, high rbc and wbc. looking for possible malignancy. CT read as negative.

9/2018. Pt p/w s/s for cystitis.
CT A/P w IV contrast.
C: 4/2018.
F: increase in size peripherally enhancing nodule at base of bladder. No evidence of cystitis.
I: Transition cell carcinoma.
Rec: Urology consult.

1/2019. 3 month follow-up CT demonstrate disease progression.

Dx: Bladder transition cell carcinoma, invasive.

12/07/2020

Hx: fell, right ankle pain and swelling.

XR ANKLE RIGHT
F: Flake of bone adjacent to dorsolateral aspect calcaneus at origin of extensor digitorum brevis. Soft tissue swelling. Small joint effusion (not shown).

I: avulsion fracture of extensor digitorum brevis.

$Lateral talar process fracture.AKA snowboarder fractures can mimic a lateral ankle sprain. Can be difficult to identify ...$

11/27/2020

Lateral talar process fracture.

AKA snowboarder fractures can mimic a lateral ankle sprain.

Can be difficult to identify on radiographs

Follow up CT or MRI is necessary to evaluate the extent of fracture and the amount of displacement of the fragments.

Grading determines treatment and prognosis.

11/18/2020

Changes 2 months make!

ER pw cough. Left breast squamous cell carcinoma s/p mastectomy 8/2018.

CXR
C: CXR 10/2018, CT 8/2018
F: New numerous pulmonary nodules and masses. Left mastectomy.
I: Metastatic dz.

Dx: Metastatic SCC to lungs.

Patient had a negative CT and CXR following mastectomy for breast SCC. Within two months develops new metastatic disease in lungs. Following chemotherapy, 3 month CT follow-up showed drastic improvement of pulmonary metastases (not shown).

11/09/2020

ER pw pain post-op abd.

Acute Abd series w CXR
C: CXR 7/2018
F: Right upper lobe lung mass increased in size. Post-operative abdomen (not shown).
I: Lung cancer.
Rec: cancer w/u.

CT: Right upper lobe mass. Adenopathy (not shown). No mets to abdomen pelvis.
MR: Brain mets. (not shown)

Dx: Met lung cancer.

Prior CXR 7/2018 done for cough was read as post-operative, no consolidation. This was a missed finding. At least in retrospect, right upper lobe mass was present though smaller. In 5 months it had at least doubled in volume.

10/30/2020

Sail Sign of Left Lower Lobe Collapse.

ER p/w abd pain. Vocal chord cancer.
CT Abdomen pelvis.
F: complete left lower lobe collapse. no evidence of metastatic dz.
I: LLL collapse.

Earlier CXR from same visit (shown) read as no acute process. This was a missed finding. Wedge-shaped consolidation in posterior retrocardiac space (Sail Sign) is typical appearance of LLL lobar collapse. Comparison made from a prior CXR same patient demonstrate COPD but otherwise normal aeration particularly of LLL.

10/28/2020

What a year 2020: covid, US elections, hurricanes, wild fires, civil unrest.

To all my old followers, thank you for sticking around, and to my new followers welcome and thank you for following my page.

I'm working to bring you new posts for the rest of the year. Stay tuned.

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