Elbow: No known injury-but missing component of lateral stabilizers

This 65-year-old presents for an elbow MRI with no known injury. Can you name the components of lateral stabilizers and what is missing? Let the arrows be your clue.

 

Dynamic stabilizers are musculotendinous extensors and these are ruptured from their origin. Static stabilizers include:

  • Lateral ulnar collateral ligament- intact (LUCL – double arrows, image one)
  • Annular ligament (not seen)
  • Accessory annular ligament (not seen)
  • Lateral capsule (torn-arrow, images two and three)
  • Proper radial collateral ligament (torn-arrow, images two and three).

For additional case review resources, check out MRI Online.

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Known tibia diagnosis, but still questions about management

This 13-year-old presents with a tibia lesion. You know the diagnosis. What should you do to recommend management?

The diagnosis is osteoid osteoma. Treat the pain with aspirin or anti-inflammatory agents. But, these lesions will burn out and should not be lasered, removed, etc. Save the whales! Save the shins of our children! Leave osteoid osteomas alone. And check out additional valuable case review on MRI Online.

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White Blob Around ACL?

What does the mass “white blob” around the ACL imply in this case? Come up with your own answer, then scroll down to see my findings.

Of course lesion is bright (except on T1), smooth oval and therefore cyst (actually a ganglion pseudocyst). Some refer to this as mucoid lesion of the ACL.

ProScan Pearl: What is implied by this lesion is abnormal friction or encroachment on femoral notch and ACL with movement (notch “impingement” or stenosis). The patient HAS a dysplasia and was born with a congenitally small dysplastic femoral notch contributing to notch impingement.

For more compelling knee case review, check out MRI Online.

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What is this primary tumor?

The arrows point to what primary tumor in this 77-year-old male with lung cancer? What’s invaded? Is it cleanly resectable? Come up with your own answers, then check below the images to see my findings. 

A Pancoast tumor (arrow) which crosses the cupola (fat pad at lung apex) of the lung, invades the brachial plexus and the vertebra. It is NOT resectable.

ProScan Pearl: Check the lung apex on every cervical spine MRI.

For more high-quality educational content, check out MRI Online.

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A look at intracapsular implant rupture

Name all the signs you can see on these sagittal T2 images from each breast. Next, name all the signs you can think of that signify MRI evidence of intracapsular implant rupture. Then be sure to scroll below the images to check your findings against mine.

Right breast (left) is collapsed; loop or lariat sign (two arrows); fall away sign (four arrows) when implant falls away from biological fibrous shell.

Left breast (on right) is normal with physiologic radial folds (arrow).

Other signs include: Linguine sign (the classic intracapsular rupture sign), and the bubble-mixing sign, both not present in this case. All represent intracapsular implant rupture.

What is the underlying disease?

Sometimes the history can change everything when it comes to evaluating a case. I wanted to show you one such example. Before you look at my findings, be sure to come up with your own answer for what you think is this patient’s underlying disease.

Case History:

  • 74-year-old with swollen toe.
  • What is the underlying disease?
  • What is the underlying deformity?
  • What finding on MRI decides if the patient has osteomyelitis?

 

Findings:

  • Underlying disease: Diabetes
  • Deformity: Bunion
  • “Erasure sign” or cortical loss on short axis T1 MRI (long arrow)
  • Infected bursitis (4 arrows) contiguous with bunion erosions (2 arrows) in the first metatarsal on MRI fat- and water-weighted imaging (images 2, 3, 4).
  • ProScan Pearl: It is common to see reactive marrow swelling on water-weighted MRI images but if the cortex is not lost on T1 MRI it is not osteomyelitis.

I’d love for you to check out more cases I’ve shared by taking a look at this complimentary course.

All the best,

SJP

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Prostate MRI: What’s his T-Stage?

Staging in prostate cases has never been more important as we work to design an individualized care plan for each patient. With that in mind, I wanted to share this case with you. Before you look at my findings, think about what T-stage you would give this case with the info provided. And what PiRad score would you assign it? The nodes and bones are normal.

Findings: T3z, or in other words probable capsular invasion on the right T2 axial and coronal MRI (short arrows). On viewer’s left (patient’s right), is diffusion restriction (high signal arrows) and low signal on ADC parametric map (arrows). Mass is over 1.5 cm in size so this is a PiRads 5.

I’d love for you to check out this instructional video I created that will help you improve you PiRad scoring, as part of a larger complimentary online prostate course. Thanks.

All the best,

SJP

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Guess that sport pulley tear

Guess that sport – MRI Case Review with Dr. Pomeranz

At ProScan, we specialize in sports injuries. We regularly read for professional sports organizations in the NFL, NHL and more. We review LOTS of MRI sports injury cases.

If you read MRI, or want to read more of it, chances are you see a lot of sports injuries, too!

I’m going to share a case with you of another athlete we saw recently who had a finger injury. I’d like for you to pause and try to guess the sport before you look at my findings. It’s a 35-year-old male with middle finger pain.

What is the injury? Which subtype or location specifically? What is most common “one” to tear? What is the most likely sport to cause this?

….

did you think about it?

….

hint: it’s not a football, hockey player or skier

Findings

  • Pulley tear, middle finger (arrows) and tendon sags towards palm or volarly.
  • A2 pulley at proximal third of proximal phalanx is injury.
  • A2 is most common to tear.

The most likely sport? Rock climbing!

Hope you enjoyed the case review. If you need to brush up on your hand injuries, check out our Medical Imaging Quick Hits, where we go through several hand cases in detail. For a more thorough hand review, complete with several cases and 2 CME, I’d recommend our MRI Case Review Series.

More to come!

SJP

P.S. Please leave us comments and reach out if you need help finding the right educational content for you (education@proscan.com).

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