Posts Categorized: ProScan Case Review

What are the best MRI next steps for a stroke patient?

This 69-year-old male presents with visual deficit. The finding on CT is a left occipital stroke. In what vascular territory is it distributed? Would the MRI be positive? More specifically, would a FLAIR MRI be positive? What about a diffusion MRI? The location of the stroke is the left posterior cerebral artery territory. FLAIR MRI… Read more »

What’s the life-threatening finding in this knee case?

This 57-year-old male presents with a large mass. What is it? But, more importantly, on these axial water-weighted MRI images, what is the potentially life-threatening finding?   The high signal mass is a gastrocnemius semimembranous bursal cyst (one of the many types of Baker’s cysts). The life-threatening finding is the absence of flow phenomena in… Read more »

Is there cause for concern in this 10-year-old with knee pain?

This 10-year-old presents with right knee pain and swelling. There is no known trauma. What’s the most likely diagnosis? What is indicated by the arrows in the back of the knee? Is it concerning?   The diagnosis is Sinding-Larsen-Johansson syndrome or inferior patellar “apophysitis” (yellow arrow). The green arrows indicate lymph nodes, and they are… Read more »

Lumps have returned for this Sjogren’s patient

This 66-year-old woman presents with parotid adenoma and Sjogren’s syndrome. History of fibroid removal surgery. Patient states she was diagnosed with Sjogren’s syndrome 12 years ago, and complains of lumps on the left side of her neck for 7-8 years, that went away and have come back in the last two months, with more lumps… Read more »

How should you repair this patient’s heel pain?

This 59-year-old presents with heel pain. Diagnosis is obvious on water-weighted sagittal MRI, but how do you repair this?   It’s an obvious plantar fasciitis with a tear. As for how to repair it, that’s a trick question. You put the patient in a boot and manage their pain. The surgical treatment for plantar fasciitis… Read more »

What is the cause of this patient’s droopy eye?

This 55-year-old female presents with a droopy eye, which isn’t something to be taken lightly. In this particular case, the droopy eye is symptomatic of a syndrome with a name you might remember.   Remember Horner’s syndrome, i.e. ptosis meiosis anhydrosis? Here is the classic cause, carotid dissection, with a meniscal curvilinear appearance of the… Read more »

What does the alpha angle suggest in this hip?

You are shown two MRI images. One is a standard orthogonal coronal with a line through it. This shows the angle of acquisition to evaluate the alpha angle. The second image is the axial oblique with the lines used for alpha angle measurement. Questions: What is a normal alpha angle? What does an abnormal alpha… Read more »

Figuring out T stage with limited imaging

This 87-year-old man presents with two cancers. Note they are unrelated and not the result of one cancer spreading to another organ. What are the two cancers? Advanced questions: Can you posit the T stage of cancer #1 from limited imaging? How valuable is diffusion imaging in the prostate as an example? Answer: Prostate and… Read more »

ADEM or MS? How to differentiate between two favored diagnoses

This 15-year-old presents with blurred vision and white-matter lesions on axial FLAIR MRI. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are the two favored diagnoses, so what questions would you ask to differentiate? You should ask: How long has this symptom been present? Is it clinically monophasic or polyphasic? Was there a recent upper… Read more »