CT, computed tomography; DVT, deep venous thrombosis; PE, pulmonary embolus; PO, per os; IV, intravenous; IgH, immunoglobulin heavy
We report a case of a 53 year old female who presented with a painless mass over her left greater trochanter. Evaluation with MRI and ultimately biopsy led to a diagnosis of fat necrosis. If this diagnosis had been considered with greater confidence, a conservative approach could have been taken and biopsy avoided. In patients with lesions demonstrating classic locations and imaging features of fat necrosis, observation without biopsy is appropriate.
MRI, magnetic resonance imaging
We report a case of a stress fracture of the scapular spine which developed as a late complication of a reverse shoulder arthroplasty. After initially doing well after surgery, our patient developed pain and decreased shoulder function. A nondisplaced scapular spine fracture was noted on radiographs. Because reverse shoulder arthroplasty is a relatively new procedure in this country, radiologists may be unfamiliar with its potential complications. Stress or insufficiency fractures of the scapular spine and acromion are a potential complication of reverse shoulder arthroplasty, due to increased functional demands of the deltoid muscle, which is often combined with deficiency of acromial bone due to rotator cuff arthropathy and osteopenia.
CT, computed tomography
We report a case of a 75-year-old female with bilateral thigh pain for several years secondary to soft tissue calcification. Massive calcinosis of the soft tissues is a unique, but not uncommon, radiographic finding. On the contrary, tumoral calcinosis is a rare familial disease. The term tumoral calcinosis has been overly used to describe any massive collection of periarticular calcification. The original definition of tumoral calcinosis refers to a hereditary disease associated with massive periarticular calcification without an underlying cause. The lesions of tumoral calcinosis are typically lobulated, well-demarcated calcifications most often distributed along the extensor surfaces of large joints. Many conditions have similar radiographic appearances, including the calcinosis of chronic renal failure, calcific tendinitis, synovial osteochondromatosis, synovial sarcoma, myositis ossificans, tophaceous gout, and calcific myonecrosis. The radiologist plays a critical role in guiding the appropriate tests that can result in a conclusive diagnosis of tumoral calcinosis.
CT, computed tomography; MRI, magnetic resonance imaging
We report the diagnosis and repair of a chronic, iatrogenic diaphragmatic hernia using minimally-invasive techniques. A 69-year-old man presented with intermittent abdominal and shoulder pain. He had previously undergone laparoscopic Nissen fundoplication in which a grasper-induced puncture injury to the left hemidiaphragm was noted but not repaired. Radiographs and CT imaging diagnosed a left diaphragmatic hernia, with stomach herniated into the left thoracic cavity. This was repaired successfully via an intra-abdominal laparoscopic approach. This case represents the potential importance of repairing post-traumatic diaphragmatic hernia at the time that they occur, as well as a minimally invasive means for their repair.
CT, computed tomography
Splenic artery aneurysms are an uncommon entity and are usually asymptomatic when diagnosed. Treatment is based on size, with aneurysms greater than 2 cm usually undergoing surgical repair. We present a case in which percutaneous thrombin injection was used for treatment of a splenic artery aneurysm.
CT, computed tomography; IV, intravenous
We report the incidental discovery of a flexor carpi radialis brevis tendon, a rare anatomical variant identified during a surgical procedure. Magnetic resonance imaging of the contralateral side helped to delineate the anatomy of the flexor carpi radialis tendon and to differentiate the flexor carpi radialis brevis tendon from it. We describe the use of this rare tendon in ligament reconstruction of the basal joint of the thumb.
FCRB, flexor carpi radialis brevis; FCR, flexor carpi radialis; MRI, magnetic resonance imaging; MR, magnetic resonance
Nodular fasciitis is a benign fibroblastic lesion that was historically misdiagnosed as a malignant neoplasm. Patients present with pain and swelling of relatively brief duration. The clinical presentation is suggestive of an aggressive lesion, usually occurring in muscle fascia. Histologic features can cause it to be mistaken for sarcoma. After the diagnosis is established histologically, observation is the suggested treatment. We present the case of a patient who had a large soft-tissue tumor in the upper arm with a clinical picture indicative of sarcoma, which ultimately was diagnosed as nodular fasciitis. The patient was treated with anti-inflammatory agents and observation. Within 7 months, the mass almost completely resolved, as documented by magnetic resonance imaging.
MRI, magnetic resonance imaging
A solid breast mass that decreases in size over time without treatment is generally felt to be inconsistent with a diagnosis of malignancy. We describe a case where this dogma proves to be incorrect. Mammographic features of a mass, along with the patient's clinical hormonal status, need to be considered along with size characteristics.
ER/PR, estrogen and progesterone receptor; HRT, hormone replacement therapy; IRB, investigational review board; SERM, selective estrogen modifiers; STAR, study of tamoxifen and raloxifene; MLO, medial lateral oblique
We report a case of an adolescent female who had an initial outside clinical and imaging presentation that was considered highly suspicious for metastatic osteosarcoma. Extensive evaluation led to the diagnosis of chronic recurrent multifocal osteomyelitis. If this etiology had been considered earlier in the patient's clinical course, her diagnostic evaluation may have been less involved and treatment could have commenced sooner. When this entity is a diagnostic possibility along with neoplasm, strong consideration should be given to proceeding directly to open surgical biopsy due to the difficulty in diagnosing this lesion from small percutaneously-obtained biopsy samples.
SAPHO, synovitis, acne, pustulosis, hyperostosis; CRMO, chronic recurrent multifocal osteomyelitis; CT, computed tomography; MRI, magnetic resonance imaging; CC, cranial-caudal; AP, anterior-posterior; ML, medial-lateral; ESR, erythrocyte sedimentation rate
We report the case of a 31-year-old male whose initial imaging presentation was considered highly suspicious for an edematous accessory muscle, the anconeus epitrochlearis. Operative excision led to the diagnosis of tophaceous gout. If this etiology had been considered earlier in the patient's clinical course, his diagnostic evaluation may have been less involved. When faced with a soft tissue mass in the setting of gout, a soft tissue tophus should always be considered.
MR, magnetic resonance
We report a case of a 4-year-old female with Sotos syndrome (cerebral gigantism) whose initial clinical, pathologic, and imaging presentation was considered suspicious for a vascular malformation of her left thigh. Following 17 months of attempted treatment, excision of the supposed vascular malformation was performed. Pathology tests revealed high-grade sarcoma. The delay of diagnosis resulted in an above-the-knee amputation for definitive treatment. If this etiology had been considered earlier in this patient’s clinical course, her treatment could have commenced sooner, and amputation of her leg may have been avoided. While soft-tissue sarcoma arising in childhood is rare, malignancy should be given consideration when evaluating a mass in a young child with characteristic physical examination findings of Sotos syndrome, since these children have an elevated risk of malignancy over the general population.
CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography
The U.S. National Press has brought to full public discussion concerns regarding the use of medical radiation, specifically x-ray computed tomography (CT), in diagnosis. A need exists for developing methods whereby assurance is given that all diagnostic medical radiation use is properly prescribed, and all patients’ radiation exposure is monitored. The “DICOM Index Tracker©” (DIT) transparently captures desired digital imaging and communications in medicine (DICOM) tags from CT, nuclear imaging equipment, and other DICOM devices across an enterprise. Its initial use is recording, monitoring, and providing automatic alerts to medical professionals of excursions beyond internally determined trigger action levels of radiation. A flexible knowledge base, aware of equipment in use, enables automatic alerts to system administrators of newly identified equipment models or software versions so that DIT can be adapted to the new equipment or software. A dosimetry module accepts mammography breast organ dose, skin air kerma values from XA modalities, exposure indices from computed radiography, etc. upon receipt. The American Association of Physicists in Medicine recommended a methodology for effective dose calculations which are performed with CT units having DICOM structured dose reports. Web interface reporting is provided for accessing the database in real-time. DIT is DICOM-compliant and, thus, is standardized for international comparisons. Automatic alerts currently in use include: email, cell phone text message, and internal pager text messaging. This system extends the utility of DICOM for standardizing the capturing and computing of radiation dose as well as other quality measures.
Data extraction; medical informatics applications; radiation dose; database management systems; knowledge base
There has been recent interest in the application of machine learning techniques to neuroimaging-based diagnosis. These methods promise fully automated, standard PC-based clinical decisions, unbiased by variable radiological expertise. We recently used support vector machines (SVMs) to separate sporadic Alzheimer's disease from normal ageing and from fronto-temporal lobar degeneration (FTLD). In this study, we compare the results to those obtained by radiologists. A binary diagnostic classification was made by six radiologists with different levels of experience on the same scans and information that had been previously analysed with SVM. SVMs correctly classified 95% (sensitivity/specificity: 95/95) of sporadic Alzheimer's disease and controls into their respective groups. Radiologists correctly classified 65–95% (median 89%; sensitivity/specificity: 88/90) of scans. SVM correctly classified another set of sporadic Alzheimer's disease in 93% (sensitivity/specificity: 100/86) of cases, whereas radiologists ranged between 80% and 90% (median 83%; sensitivity/specificity: 80/85). SVMs were better at separating patients with sporadic Alzheimer's disease from those with FTLD (SVM 89%; sensitivity/specificity: 83/95; compared to radiological range from 63% to 83%; median 71%; sensitivity/specificity: 64/76). Radiologists were always accurate when they reported a high degree of diagnostic confidence. The results show that well-trained neuroradiologists classify typical Alzheimer's disease-associated scans comparable to SVMs. However, SVMs require no expert knowledge and trained SVMs can readily be exchanged between centres for use in diagnostic classification. These results are encouraging and indicate a role for computerized diagnostic methods in clinical practice.
MRI; diagnosis; dementia; support vector machine