Musculoskeletal Imaging
Tuberculous osteomyelitis of the scapula masquerading as metastasis by Ashish Singh et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 27-31
| Abstract: Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula. This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.
Available image modalities: (click on modality to browse for other articles) Computed Tomography, Nuclear Medicine, Ultrasound, Microscopic pathology, Conventional Radiography
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Neuroradiology
Mount Fuji sign with concavo-convex appearance of epidural haematoma in a patient with tension pneumocephalus by Amit Agrawal et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 10-12
| Abstract: Intracranial pneumatocele is a non-infected accumulation of air within the cranial cavity. We report a case of a 22-year-old male who sustained a fracture of anterior cranial fossa following a motor vehicle accident and the imaging findings showed a concave-convex epidural haematoma. Simple traumatic pneumocephalus usually does not require surgical treatment and non-operative management has been advocated for small, asymptomatic convexity extradural haematomas.
Available image modalities: (click on modality to browse for other articles) Computed Tomography, Magnetic Resonance Imaging
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Pediatric Radiology
Cord Compression due to Extramedullary Hematopoiesis in an Adolescent with Known Beta Thalassemia Major by Salil Soman et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 17-22
| Abstract: We describe a 16 year-old male with ß thalassemia major and gait disturbances that had not been given blood transfusions due to a severe childhood transfusion reaction. Thoracic spine MRI demonstrated hematopoietic marrow throughout the spine and epidural masses causing cord compression consistent with extramedullary hematopoiesis (EMH). After treatment with steroids, radiotherapy and monitored blood transfusions, the patient demonstrated significant improvement of his paraspinal lesions and near complete resolution of his neurological symptoms. While EMH causing cord compression in adolescents is rare in the current era of bone marrow transplantation or chronic transfusions, it should be considered when thalassemia major patients present with neurological deficits. The well defined imaging features of EMH can play a central role in its diagnosis and management, especially because surgical and / or radiotherapeutic intervention are often considered in cases of failed medical treatment.
Available image modalities: (click on modality to browse for other articles) Magnetic Resonance Imaging
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Pediatric Radiology
Sacral Ewing`s Sarcoma and Challenges in it`s Diagnosis on MRI by Santhanagopal Srinivasalu et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 23-26
| Abstract: A 15-yr old boy presented with low backache for 4 months associated with weakness of left lower limb. MRI of lumbosacral spine showed a sacral lesion with intraspinal and presacral soft tissue extension with neural compression. A diagnosis of tuberculosis was considered in the view of high prevalence in this part of the world, however biopsy revealed Ewing`s sarcoma. Ewing`s tumor of sacrum is rare, but should be suspected in low backache in children. Differential diagnosis for a sacral lesion includes tuberculosis, pyogenic osteomyelitis, lymphoma, chordoma, osteosarcoma and Ewing`s sarcoma. MRI is sensitive in detecting these lesions but is nonspecific requiring histopathological examination for confirmation.
Available image modalities: (click on modality to browse for other articles) Conventional Radiography, Magnetic Resonance Imaging, Computed Tomography
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Pseudotumoural gastric lesion caused by fish bone perforation by Walid Al-Deeb et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 13-16
| Abstract: We report the case of a 34-year-old previously fit and healthy male who presented to the accident & emergency department with non-specific abdominal pain. The patient proceeded to undergo laparotomy at which a large mass was found adjacent to the stomach. The impression at surgery was of a lymphoma or gastric carcinoma though CT had reported the likelihood of a fish bone or foreign body causing duodenal perforation. Histology later confirmed the presence of a fish bone surrounded by reactive tissue.
Available image modalities: (click on modality to browse for other articles) Computed Tomography, Macroscopic pathology, Microscopic pathology, Conventional Radiography
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Lateral abdominal wall hernia following blunt trauma – a rare case by Nnamdi Nwaejike et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 7-9
| Abstract: The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.
Available image modalities: (click on modality to browse for other articles) Clinical Image, Computed Tomography, Conventional Radiography
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Interventional Radiology
Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava by Marc Gingell Littlejohn et al. |
Published: 2009 Jan Issue: 3(1) :: Pages: 3-6
| Abstract: We present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA) and the inferior vena cava (IVC), successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ) obstruction and recurrent pyelonephritis. It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.
Available image modalities: (click on modality to browse for other articles) Angiography, Interventional
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