Aftermath of a motor vehicle accident

This 45-year-old male presents with lower back pain due to a motor vehicle accident. Have a look at images 1 through 7, and see how many findings catch your eye.

Sagittal T2

Sagittal STIR

Sagittal T1

Sagittal T1

Sagittal STIR

Sagittal T2

Axial T1

 

Bone marrow edema within the L3 and L4 vertebral bodies nearly encompasses the entire L3 vertebral body and the majority of the L4 vertebral body, and is associated with hyperintense signal within the intervertebral disc. Patient is post left laminotomy at this level. Edema and swelling track along the left laminotomy site.

After administration of intravenous contrast, the surgical site was enhanced via enhancement of the paravertebral soft tissues along the intervertebral disc space (image 7, pink arrows), anteriorly. Furthermore, extensive abnormal heterogeneous signal within the thecal sac, starting at the level of L2-L3 and extending to the sacrum, has peripheral enhancement with central low signal (image 3, purple arrow).

Patient history also indicated discitis osteomyelitis at the L3-L4 level. Combination of these findings are compatible with discitis / osteomyelitis at L3-L4 with a prevertebral soft tissue collection, involvement of the epidural space along the left laminotomy site dorsal aspect of L3-L4, and an enhancing intradural abscess extending from L2-L3 to the sacrum.

Vertebral body heights are preserved. There is a loss of intervertebral disc space height at L3-L4 with active inflammation and edema. Remaining intervertebral disc space heights are preserved with varying degrees of mild disc desiccation.

The thoracolumbar junction is intact. Spinal canal is mildly congenitally narrowed with subtle retrolistheses of L3 on L4, and L4 on L5.

Conus medullaris is visualized at L1-L2. Cauda equina nerve roots are displaced and irregular extending from the conus to the distal thecal sac due to the intradural soft tissue and fluid collection.

 

Clinical considerations as you might report them:

T12-L1: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Mild facet arthropathy is indicated.

L1-L2: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Mild facet arthropathy is indicated.

L2-L3: There is no focal disc herniation or spinal canal stenosis. The neural foramina are patent. Bilateral facet arthropathy is indicated. Cystic soft tissue within the thecal sac at this level extends to the distal thecal sac.

L3-L4: Patient is post remote left laminotomy at this level. Bilateral facet arthropathy is indicated. Irregular cystic soft tissue within the thecal sac is present without high grade spinal canal stenosis. Left neural foramen is moderately narrowed. Right neural foramen is mildly narrowed.

L4-L5: Subtle retrolisthesis of L4 on L5 with a shallow concentric spondylotic disc displacement. Irregular soft tissue within the thecal sac extends towards the sacrum. Bilateral facet arthropathy encroaches upon the neural foramina resulting in mild-moderate foraminal narrowing.

L5-S1: Shallow concentric disc displacement without spinal canal stenosis. The neural foramina are patent. Bilateral facet arthropathy. Abnormal soft tissue and enhancement within the thecal sac extends towards the sacrum.

Present is left paraspinal muscle edema, and enhancement along the surgical tract at the level of L3-L4 left laminotomy site.

Visualized soft tissues of the abdomen and pelvis are grossly unremarkable.

 

Conclusion as it might appear:

  • Discitis / osteomyelitis at L3-L4 with anterior prevertebral phlegmonous changes
  • Edema and enhancement tracking along the left laminotomy site at this level
  • Associated abnormal heterogeneous peripheral enhancing soft tissue / fluid within the thecal sac from the level of L2-L3 extending to the sacrum compatible with intradural abscess
  • Mild spondylosis

 

If you enjoyed this case you may also enjoy:

Left-sided tinnitus. No IAC mass. What is the next step in the diagnostic algorithm?
Tinnitus and left facial droop and hearing loss (oh my)
What should you do with this tricky skull base case?

For more case review, check out MRI Online.

Dr. Stephen Pomeranz

Dr. Benjamin J. LeSar

 

Newsletter Signup

Then Wrisberg said, “That tears it!”

This 19-year-old male presents with left knee pain. The patient had an anterior cruciate ligament (ACL) repair three years prior.

When looking through the images, think about the following questions:

Q1 – What is a common pitfall when diagnosing meniscal tears of the posterior horn of the lateral meniscus?

Q2 – How can a Wrisberg rip be diagnosed with confidence?

Q3 – What major injury is associated with a Wrisberg rip?

Q4 – Vertical posterior sliver tears adjacent to the capsule of the medial meniscus are associated with which major injury?

Sagittal PD (Images 1 – 5)

 

Coronal T2 SPIR

Sagittal PD

Coronal T2 SPIR

Sagittal PD

Coronal T2 SPIR

Sagittal PD

 

As hinted, this case is that of a Wrisberg rip. A Wrisberg rip can be difficult to accurately diagnose. There is normally a cleft between the Wrisberg ligament (images 7 and 8, yellow arrows) as it attaches to the posterior horn of the lateral meniscus (images 7 and 8, pink arrows), and this cleft of high signal can be misdiagnosed as a tear. However, when abnormally high signal extends beyond the posterior root, and into the posterior horn towards the body, a pathological tear can be diagnosed with confidence.

In this case, the coronal images clearly demonstrate lateral extension of high signal towards the lateral posterior horn / body junction over a length of 2 to 3cm (image 6, blue and red arrows). It can also be traced with its oblique orientation from anterosuperior to posteroinferior on the sagittal images (images 1 – 5, green arrows) along its mediolateral length, confirming the pathological nature of this finding.

A Wrisberg rip is associated with anterior cruciate ligament rupture. In this case, the patient has a ruptured anterior cruciate ligament graft (image 9, orange arrow).

Also associated with anterior cruciate ligament rupture, is a vertical sliver (“linear”) tear, or peripheral rim tear, adjacent to the posterior and medial capsule (image 10, purple arrow; image 11, green arrow) of the body and posterior horn of the medial meniscus. Whether these meniscal injuries occurred with the initial anterior cruciate ligament rupture, or subsequent rupture of the graft, is indeterminate. However, a chronic time frame is favored. You can often tell if these tears are new by their higher signal, and more intense swelling around them.

 

A1 – Attachment of the Wrisberg ligament onto the posterior horn of the lateral meniscus can produce a high signal cleft that can be misdiagnosed as a tear, but is actually a normal variant. It’s typical course is anterosuperior to posteroinferior.

A2 – When abnormal signal is seen to track from the posterior root through the posterior horn and towards the body. In other words, the normal Wrisberg reflection is only seen on one or two sagittal slices.

A3 – Anterior cruciate ligament rupture.

A4 – Anterior cruciate ligament rupture.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

There is pain and swelling, but where is the source?
He didn’t like what was on his plate, but couldn’t return it
ACL contusion patterns: The importance of medial sided contusions

 

Dr. Stephen Pomeranz

Dr. Stephen Repse

 

Newsletter Signup

A wrist’s tale: When pain met swelling

This 15-year-old female presents with anterior right wrist pain and swelling. There is no known injury or prior surgery. Have a look at images 1 through 6, and see if you can answer the following questions.

Q1 – What is the most likely diagnosis in this 15-year-old female with a mass of the volar aspect of the forearm?

Q2 – What are the low-signal filling defects within the lesion?

Coronal T1

Coronal T1 (Post-contrast)

Coronal T2

Gradient

Axial T1

Axial T2

 

A1 – Venous malformation (formerly hemangioma).

Vascular anomalies are divided into two major groups. The first are vascular tumors that arise due to vascular proliferation, and are called hemangiomas. The second group of lesions are called vascular malformation, and arise because of inborn errors in morphogenesis.

Vascular malformations are classified according to the dominant distorted vessel type, and include capillary, lymphatic, and venous malformations. Vascular malformations are also categorized into low-flow and high-flow groups which is important for treatment of the lesions. Hemangiomas, on the other hand, occur in infancy, have rapid neonatal growth, and slowly involute. Venous malformations can occur anywhere in the body, and can present with pain at rest or during exertion.

A2 – Phleboliths.

Phleboliths are seen in some, but not all, venous malformations. MRI is the study of choice for evaluation of vascular malformations. Imaging of vascular malformations present as high-signal, tubular-like structures (image 9, arrows). The presence of fat could be an indicator of muscular atrophy secondary to vascular insufficiency. Gradient-echo sequences may reveal low signal related to phleboliths or hemosiderin (image 10, arrows). Variable enhancement is noted after gadolinium administration (image 8, arrows). In the orbit, venous malformations frequently overlap with lymphatic malformations (“lymphangiomas”) and vice-versa.

Coronal T1

Coronal T1 (Post-contrast)

Coronal T2

Gradient

Axial T1

Axial T2

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

While observing the mass, we noticed she had a tail
Anatomy is king (or queen) in this wrist case
How does this 61-year-old’s wrist diagnosis differ from a young athlete’s?

 

Dr. Stephen Pomeranz

Dr. Robert Wissman

 

Newsletter Signup

She really put her shoulder into moving that desk

This 59-year-old female presents with left shoulder pain. The pain began three years earlier after moving a heavy desk, and has progressively worsened even after physical therapy. There is also limited range of motion. Have a look at the highlighted regions of images 1 through 7, and see if you can identify the potential cause of this patient’s symptoms.

Q1 – When abnormal signal is detected in the rotator cuff, what other features should help guide interpretation as to the primary cause for this appearance?

Coronal STIR

Sagittal T1

Coronal STIR

Coronal T1

Coronal T1

Sagittal T1

Coronal STIR

 

This is a case of subacromial impingement coexisting with likely subclinical fibroinflammatory capsulitis. There is clear:

  • Subacromial stenosis
  • Impingement with a thick coracoacromial ligament (CAL) (image 1, pink arrow)
  • A moderate to large amount of bursal fluid (image 3, blue arrow)
  • Peritendinobursitis (image 1, green arrow) of the superior cuff with tendinopathy (image 7, green arrows) consisting of small, but deep, interstitial tears of the supraspinatus (image 2, red arrows)

Therefore, subacromial impingement, and associated tendinopathy and peritendinobursitis, are the most likely cause for the patient’s symptoms.

Although uncommonly seen at the same time, fibroinflammatory capsulitis can coexistent with impingement. They coexist more commonly with partial, rather than communicating full-thickness, tears. This is because a communicating tear allows for inflammatory decompression into the bursal space, and prevents concentric contraction. As indicated above, adhesive capsulitis infiltrates the rotator cuff, and may produce T1 “grey” cuff ghosting. Sometimes infiltrative adhesive capsulitis and small partial tears may overlap or be difficult to differentiate. This is demonstrated by the thickening of the inferior glenohumeral ligament (image 4, yellow arrow) and anterior rotator interval (image 4, purple arrow), as well as a mild “corona sign” (image 6, yellow arrows). Additionally, note that there is no fluid in the axillary recess (image 5, orange arrow). In this case, the abnormal signal in the supraspinatus tendon is not interpreted as being primarily due to infiltrative fibroinflammatory capsulitis; the dominant features of impingement.

 

A1 – Other associated or contributing factors would be:

  • Subacromial impingement
  • Abnormal shape of the acromion
  • Thickening of the coracoacromial ligament
  • Associated rotator cuff tears
  • Presence of peritendinobursitis

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

It’s as if her shoulder was “frozen”
Can you classify this shoulder injury?
What is the cartilage telling us?

 

Dr. Stephen Pomeranz

Dr. Stephen Repse

 

Newsletter Signup

They in’cyst’ed that we have a histological review

This 62-year-old female presents with a left wrist mass that has recurred five times after two prior drainages and two prior surgical removals.

Images 1 and 2 are in the short-axis view. Based on image 1 (a proton-density non-fat-suppressed image), and image 2 (a T2 fast spin-echo image with fat suppression):

Q1 – What is your diagnosis?
Q2 – Why do you think this abnormality continues to recur?
Q3 – What is the most likely origin of this mass in the wrist?

Based on image 3 (a coronal fat-suppressed proton-density image):

Q4 – What is the source of this abnormality?

While looking at images 4, 5, and 6, think about the following:

Q5 – How do a ganglion, a perimeniscal cyst of the knee, and a paralabral cyst of the shoulder, associated with meniscal and labral tears, differ histologically?

Axial PD

Axial T2

Coronal PD

Axial PD

Axial T2

Coronal PD

 

A1 – Ganglion pseudocyst.

A2 – The site of weakness or source of the mass has not been addressed.

A3 – The dorsal scapholunate capsule, usually near or proximal to the dorsal intercarpal ligament and / or dorsal long radiolunate ligament.

A4 – Lunatotriquetral capsule.

A5 – They are identical. It is the site of origin that differs. A ganglion, a perimeniscal cyst of the knee, and a paralabral cyst of the shoulder are all pseudocysts lined by fibrous tissue with mucoid content.

While these entities are histologically identical, the:

  • Ganglia arise from diffusion through a microscopic weakness or defect in the capsule or sheath of the tendon. These are often difficult to visualize on MRI.
  • Perimeniscal pseudocysts in the knee arise most commonly from a cleavage tear which usually communicates with the articular surface, but sometimes is intrameniscal and “blows out” the periphery of the meniscus.
  • Paralabral pseudocysts arise from labral tears that are widely gaping, healed, or partially healed (i.e. the tear is not always seen).

Either a perimeniscal or paralabral cyst can be macroscopic events where synovial fluid transgresses an open defect, or similar to a ganglion, can diffuse through very small defects. Frequently, the location or position of the pseudocyst is a dead giveaway to its origin; one must learn where these pseudocysts arise. For example, in the wrist, ganglia are far more common than perimeniscal cysts that arise from triangular fibrocartilage complex (TFC) tears. On the other hand, in the shoulder, ganglion pseudocysts are far less common than paralabral cysts arising from the superior labrum extending over the spinoglenoid rim, and involving the suprascapular notch.

The arrows in images 4, 5, and 6 show ganglion pseudocysts dissecting into the lunatotriquetral interval, a much less common site of origin than the scapholunate dorsal region for this abnormality. Oversewing or repair of the dorsal scapholunate capsule and adjacent extrinsic ligaments is necessary to prevent recurrence. This will require open visualization of the area.

Diagnosis: Dorsal ganglion pseudocyst with a “tail” to the lunatotriquetral capsule, and dissecting into it.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

While observing the mass, we noticed she had a tail
Anatomy is king (or queen) in this wrist case
How does this 61-year-old’s wrist diagnosis differ from a young athlete’s?

 

Newsletter Signup

Accessory muscles in the medial ankle

Today, we are examining accessory muscles of the ankle. To start us off, have a look at images 1 through 5. The areas of focus have been highlighted with arrows. What extra structure do you see in the tarsal tunnel?

As a review, the normal tarsal tunnel contains:

  • Posterior tibial tendon (PT) (image 5, red arrow)
  • Flexor digitorum longus tendon (FDL) (image 5, blue arrow)
  • Flexor hallucis longus tendon (FHL) (images 1, 4, 5, and 6, green arrows)
  • Posterior tibial neurovascular bundle comprised of the tibial nerve (divides into the medial and lateral plantar nerves), and the posterior tibial artery and vein

Axial T2 (Right ankle; 50-year-old male)

Axial T1 (Left ankle; 48-year-old female)

Coronal T1 (Right ankle; 16-year-old female)

Sagittal T1 (Right ankle; 16-year-old female)

Axial T1 (Left ankle; 49-year-old male)

 

The additional structure is the peroneocalcaneus internus (PCI) (images 1-5, yellow arrows); a rare accessory muscle in the posteromedial ankle. The PCI can originate from the inner / medial aspect of the distal fibula, and inserts onto a small tubercle on the medial calcaneus, inferior to the sustentaculum tali. The PCI is estimated to be present in approximately 1% of patients, and is usually asymptomatic. When symptoms occur, they may be caused by crowding of the tarsal tunnel, with compression of the neurovascular bundle. PCI can also be associated with posterior impingement.

Although uncommon, the PCI is an important structure to be aware of during endoscopic surgery via the posteromedial portal. In this approach, the surgeon probes anterior to the FHL to reach the medial talar dome for repair of Osteochondritis dissecans (OCD) or removal of loose bodies (see Diagram 1). This path avoids the tarsal tunnel neurovascular bundle. However, if the PCI is mistaken for the FHL, probing anterior to the PCI risks injury to the neurovascular bundle, which can lie medial and anterior to the PCI. The key to identifying the PCI is that it courses posterolateral to the FHL, and hence its alternate name, the “false FHL”.

Diagram 1. Ankle PCI Accessory Tendon – Axial

 

Other accessory muscles of the medial ankle include the flexor digitorum accessorius longus (FDAL) and the tibiocalcaneus internus. The FDAL (images 6, 8, and 9, pink arrows) is actually the most common medial ankle accessory muscle; even more common than the PCI. The FDAL is posteromedial to the FHL, and can either be superficial / medial, or posterior to the tarsal tunnel neurovascular bundle. The FDAL has a variable origin, and can arise from the tibia, fibula, FHL, or the soleus, and inserts onto the quadratus plantae or FDL.

The tibiocalcaneus internus (not shown) is the rarest among the medial accessory muscles, originating from the medial crest of the distal tibia and inserting onto the medial calcaneus, 1-2 cm anterior to the Achilles insertion.

The accessory soleus (images 7, 8, and 9, orange arrows) is another accessory muscle to be aware of in the medial ankle. It is distinguished by the fact that it lies medial to the flexor retinaculum, and is therefore located external to the tarsal tunnel. Whereas, the other accessory muscles lie deep to the flexor retinaculum, and are located within the tarsal tunnel. The accessory soleus originates from the soleus muscle, or the tibia and fibula, and inserts onto the posteromedial calcaneus.

Axial T1 (Right ankle; 43-year-old female)

Axial T2 (Right ankle; 39-year-old female)

Axial T2 (Left ankle; 54-year-old female) **Rare case of two accessory muscles in the same foot**

Sagittal T1 (Left ankle; 54-year-old female) **Rare case of two accessory muscles in the same foot**

 

In summary, the accessory medial ankle muscles are important structures to recognize as potential causes of tarsal tunnel syndrome, as these can contribute to medial pain in otherwise normal-appearing ankle MRI exams.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

Why is this patient still in pain eight months after surgery?
There are three ligamentous structures. Are you up for the challenge?
What rare condition can be seen in this 29-year-old’s foot?

 

Dr. Stephen Pomeranz

Dr. Hyun Song

 

Newsletter Signup

His villi were filled with fronds

This 60­-year­-old male presents with left shoulder pain. The key areas of focus in this case have been highlighted.

Q1 – What is the most likely diagnosis of the intraarticular mass? For clues, you can also check out this case: Upon checking out the joint, we found lots of bodies

Coronal T1 SE

Coronal T1 SE

Coronal T2

Coronal T2

Axial PD

Axial PD

Sagittal T2

Sagittal T2

 

A1 – Lipoma arborescens.

Lipoma arborescens is an uncommon condition of the synovial lining of the joints and bursae with frond-like deposition of fatty tissue. Patients typically present in the 5th through 7th decades. The most common site of involvement is the suprapatellar bursa of the knee. However, other joints may be infected including the hip, shoulder, wrist, and elbow. Histologically, the normal synovium is replaced by hypertrophic villi demonstrating deposition of mature lipocytes. MRI is the modality of choice for diagnosis of these lesions which follow signal intensity of fat on all sequences.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

What can happen when you combine a 33-year-old shoulder with weight-lifting?
Be kind to your AC joint. It can only take so much.
Can you classify this shoulder injury?

 

Dr. Stephen Pomeranz

Dr. Robert Wissman

 

Newsletter Signup

Upon checking out the joint, we found lots of bodies

This 54-year-old male presents with right knee pain that has continued for a year with no known injury. Have a look at images 1 through 3, and see if anything stands out.

Q1 – What is the most likely diagnosis?

Q2 – What is the differential diagnosis for the intraarticular bodies?

Coronal PD Fat Sat

Sagittal PD Fat Sat

Axial T2

 

A1 – The most likely diagnosis is primary synovial chondromatosis. Synovial chondromatosis is a rare monoarticular process characterized by cartilaginous bodies. Primary synovial chondromatosis has a predilection for the large joints, including the knee, hip, elbow, and shoulder, although it can be identified in any joint or tendon. It affects males more frequently than females, and it is most common in the third to fifth decades. The MRI signal characteristics of the intraarticular bodies varies depending on the amount of calcification and / or ossification (images 5 and 6, arrows). Rare, but primary synovial chondromatosis can undergo malignant degeneration.

A2 – Secondary synovial chondromatosis is more common than primary synovial chondromatosis. It usually presents in the setting of longstanding osteoarthritis. In this patient, note that the medial and lateral compartments of the joint space are preserved. Only a small marginal erosion of the medial tibial plateau is noted (image 4, green arrow). Secondary synovial chondromatosis does not undergo malignant degeneration.

Rice bodies would be an unlikely consideration in this individual who is male, middle-aged, and presents with a monoarticular arthritis as rice bodies are commonly identified in inflammatory arthropathies such as rheumatoid arthritis and tuberculous infections. They are smaller than synovial chondromatosis. Other intraarticular masses to potentially consider are pigmented villonodular synovitis (PVNS) which has diffuse and focal forms, and would not present as nodular densities, but as a mass. Blooming may occur on gradient images due to a lack of refocusing pulse on this sequence, and due to siderotic components. Lipoma arborescens is most commonly found in the suprapatellar bursa and follows fat signal. Synovial hemangiomas are typically high in signal on T2-weighted images.

Coronal PD Fat Sat

Sagittal PD Fat Sat

Axial T2

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

What can be learned from this 17-year-old’s knee injury?
What type of tear is causing this 20-year-old athlete’s knee pain?
How should you approach this 24-year-old’s knee case?

Dr. Stephen Pomeranz

Dr. Robert Wissman

 

Newsletter Signup

When one projection just isn’t enough

This 53-year-old male patient presents with pain and catching of the right shoulder when lifting the arm above the head. You are shown proton density fat suppression sequences using STIR short T1 inversion recovery in the coronal and sagittal projections. The patient has a rotator cuff tear.

Q1 – Is the tear full thickness? Look at the blue arrow on image 1 before you make your decision.

Coronal STIR

 

Q2 – When you have made your decision in question 1, check out images 2 and 3. Note the additional pink arrow on image 2, as well. What do you think the blue arrow represents?

Coronal STIR

Sagittal STIR

 

A1 – The tear is not full thickness. It appears ominous and perhaps full thickness in the coronal projection (image 2, pink arrow), but that is because the outer shell fibers are curved and “en face” to the coronal image. However, in the sagittal projection (image 3), a clear hypointense outer shell (pink arrow) covers a partial thickness tear (yellow arrows).

This is a terribly important teaching point, namely that full thickness tears should appear to communicate with the bursal space in two projections. The outer low signal shell (image 3, pink arrow) confirms this in the sagittal projection. Additionally, the patient had surgery affirming the presence of a partial, not full thickness communicating, tear.

A2 – The blue arrow (images 1 and 2) points to the hypertrophied markedly thickened coracoacromial ligament which is often responsible for outlet related stenosis and clinical impingement syndrome. When the patient abducts, the rotator cuff comes in contact with the acromion and thickened coracoacromial ligament where it is repetitively “pinched” or impinged, especially in internal rotation.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

Can you classify this shoulder injury?
What is the cartilage telling us?
Don’t mix up the primary and secondary forms of this disorder

 

Newsletter Signup

It’s hip, it’s obscure, it’s the case of the day

This 39-year-old female presents with hip pain that has continued for four months. Neither a cortisone shot, nor physical therapy could relieve the pain. Have a look at coronal images 1 and 2.

Q1 – What is the most likely diagnosis?
Q2 – Is this entity more common in males or females?

Coronal STIR

Coronal STIR

 

A1 – The most likely diagnosis is proximal iliotibial band (ITB) syndrome.
A2 – Proximal ITB is more common in females.

Proximal ITB syndrome is related to a strain or injury of the iliotibial band enthesis where the ITB attaches to the iliac tubercle. This entity is newly described by Sher et al. in 2011*, with few reports currently existing in literature. As such, little is known about the cause or treatment options.

To date, most results suggest there is a strong female predisposition; some of which are active runners. Others are non-athletic, some of which have a prior traumatic injury. Most commonly, patients are middle aged.

In magnetic resonance imaging, proximal ITB syndrome presents as areas of increased signal intensity adjacent to the iliac tubercle. Partial or complete disruption of the ITB may occur. The appropriate therapy is unknown. It is likely conservative for most patients.

*Reference: Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it? Skeletal radiology. 2011;40(12):1553-6.

 

Check out MRI Online for more case review.

If you enjoyed this case, you may also enjoy:

Can you see why this patient has muscular pain and swelling?
What is the diagnosis for this former pro athlete with hip and groin pain?
Can you pass the test in analyzing this athlete’s thigh injury?

Dr. Stephen Pomeranz

Dr. Robert Wissman

 

Newsletter Signup