Implications of lung shunt fraction calculation discrepancy in Yttrium-90 radioembolization treatment from 2D planar vs 3D single photon emission CT imaging.

The safety and efficacy of Yttrium-90 (Y-90) radio-embolization therapy is partly dependent on the lung shunt fraction (LSF). There may be a notable disparity between LSF when calculated using 2D planar imaging vs 3D single photon emission CT (SPECT); this can affect the total allowable Y-90 dose delivered and therefore change the effectiveness of the procedure. The case presented demonstrates an 81% decrease in LSF when calculated by SPECT as compared to 2D planar imaging. This case highlights the importance of considering the imaging technique and the potential discrepancies that can arise between planar and SPECT imaging in LSF assessment.

Combined paraganglioma and IgG4-related retroperitoneal fibrosis.

A paraganglioma is a neuroendocrine tumor that may secrete catecholamines and present with symptoms of sympathetic overload such as hypertension and diaphoresis. It is important that paragangliomas are identified, as they must often be treated by surgical excision. IgG4-related retroperitoneal fibrosis (IgG4-RPF) is a systemic inflammatory disease that results in the infiltration of IgG4-positive plasma cells in the retroperitoneum. Such fibrosis may adversely affect nearby organs and tissues. Here, we describe a case of combined paraganglioma and IgG4-RPF in a 47-year-old female patient. This case demonstrates the deleterious effect of these two conditions when they occur simultaneously.

Trunnionosis and prosthesis dissociation after total hip arthroplasty.

Femoral neck trunnion dissociations are rare complications of total hip replacements. This hardware failure is often due to underlying trunnionosis which is important to recognize. We present a case of a patient with dissociation at the femoral head-neck junction of a total hip arthroplasty (THA) with a Stryker Accolade TMZF femoral stem. There was no significant preceding trauma. The complication was visualized on radiography and confirmed during revision arthroplasty.

Migration of the os peroneum: An enigmatic phenomenon explored through radiological perspectives.

The os peroneum is an accessory ossicle located along the lateral aspect of the cuboid bone. Its position can serve as an indicator of peroneus longus tendon (PLT) injury. Imaging studies including radiographs and MRI can help detect malposition of the os peroneum and progressive injuries to the PLT and its associated structures. We report a case of a woman with recurrent foot and ankle pain, demonstrating progressive retraction of the os peroneum, implying severe PLT injury which may have ultimately predisposed her to a traumatic fifth metatarsal base fracture. This case highlights the importance of scrutinizing the appearance and position of the os peroneum on radiographs.

Sternal stress fracture presenting as acute chest pain.

Sternal fractures are rare and are typically caused by major trauma such as motor vehicle collisions. However, sternal insufficiency fractures can occur with minimal to no trauma in patients with exaggerated thoracic kyphosis from multiple thoracic compression fractures, especially in the setting of osteoporosis. We describe a case of a sternal insufficiency fracture that presented as chest pain resembling a myocardial infarction. As sternal insufficiency fractures may vary in clinical presentation, this case demonstrates that radiologists should carefully evaluate the sternum, especially when risk factors are present. Furthermore, awareness and identification of these fractures can prevent unnecessary cardiac workups.

Intraprosthetic dislocation of dual-mobility total hip arthroplasty implant.

Dual-mobility total hip arthroplasties were developed to decrease the risk of dislocation and instability seen with traditional fixed-bearing total hip arthroplasties. However, dual-mobility constructs, notably the first-generation design, come with a risk of intraprosthetic dislocation (IPD). These dislocations occur when the polyethylene femoral head component is dislodged, causing direct articulation between the inner ceramic femoral head and the metal acetabular shell. This is different than a polyethylene liner dislocation in a standard total hip arthroplasty. Causes of IPD include polyethylene wear and iatrogenic dislocation from closed reduction attempts. Timely identification is essential to reduce the risk of soft tissue metallosis, raised cobalt and chromium levels, and the need for major revisions. This complication can be seen on imaging, but radiologists must be aware of the various components and mechanisms of failure to recognize this unique complication. We present a case of a dual-mobility construct with IPD between the femoral head components, illustrated on radiographs and CT and subsequently confirmed at the time of surgery.

Failed transtibial pullout repair of the medial meniscus posterior root.

Transtibial pullout repair is increasingly being utilized for repair of meniscal root tears. Loosening and suture pullout may occur after such a repair but has not been reported in the radiology literature. We present a case of a transtibial pullout repair complicated by suture pullout, recognized on MRI and confirmed on subsequent arthroscopy. This complication may occur in the immediate postoperative period and is important to recognize as it requires surgical management.

Adverse reaction to metal debris with accompanying gout and amyloid deposits in hip arthroplasty.

Adverse reaction to metal debris (ARMD) is a known complication of metal-on-metal hip arthroplasty. There has been one previously reported case of ARMD with concomitant gout in the setting of a hip arthroplasty. We report a case of ARMD with accompanying monosodium urate crystals as well as amyloid deposition in the hip of a patient who had undergone a metal-on-metal hip arthroplasty. This is the only published case to date of these 3 conditions co-existing, although it is possible that the incidence is higher since these require special diagnostic tests that are not routinely performed. It is postulated that these entities are biochemically associated with each other rather than being purely coincidental.

Extraskeletal Ewing sarcoma of the sciatic nerve.

Extraskeletal Ewing sarcoma (EES) is a rare tumor diagnosed in children or young adults and is even more unusual in individuals over 30 years of age. Due to its rare occurrence and low index of suspicion, this tumor can pose diagnostic and therapeutic challenges. We present a case of a 60-year-old male with EES of the sciatic nerve, an unexpected entity given the patient's age, tumor type, and tumor location. This can mimic a nerve sheath tumor on imaging.

Sclerotic lumbar chordoma: A case report.

Chordoma is a rare tumor, often occurring in the cervical spine and sacrococcygeal spine with a lytic appearance, but rarely in the thoracolumbar spine. Chordomas can occasionally be sclerotic and are included in the differential diagnosis for an ivory vertebra. We present a case of a sclerotic chordoma in an upper lumbar vertebral body with corresponding multimodality imaging. This case demonstrates that chordoma should be a concern for an older adult with a sclerotic vertebral lesion, particularly if it is a solitary lesion. Knowledge of the variable location and appearance of chordomas is critical so it is not mistaken for a metastasis.

Trans-scaphoid lunate dislocation: A case series.

Trans-scaphoid lunate dislocation with volar displacement into the wrist/distal forearm is a devastating injury that most commonly occurs under situations of forceful impact to an extended wrist. Due to ligamentous disruption as well as fragile blood supply, these Mayfield type 4 injuries are associated with significant morbidity and long-term sequelae. Current treatment approaches to lunate dislocations depend on the severity and chronicity of the injury in addition to patient factors, with operative management potentially including ORIF or proximal row carpectomy. We report 5 cases of this rare injury pattern in 4 different patients.

Sweet syndrome with osseous and splenic involvement: A case report.

Sweet syndrome is an uncommon inflammatory skin condition. Here we present a case of Sweet syndrome in a young woman with rare extracutaneous manifestations, including bone and splenic fluid collections, with marked improvement following treatment with systemic corticosteroids. The patient was subsequently diagnosed with Crohn's disease which can be seen in the setting of Sweet syndrome. Sterile abscesses should be considered in patients with a clinical diagnosis of Sweet syndrome and focal symptomatology.

Ureterosciatic hernia with concomitant Amyand hernia: Case report and review of the literature.

Ureterosciatic hernias are extremely rare, with fewer than 40 cases reported in the literature. We present a case of a patient with concurrent right ureterosciatic hernia (Lindbom hernia), ipsilateral bladder hernia, and appendix-containing inguinal hernia (Amyand hernia). These findings were discovered incidentally on imaging and the patient had no associated symptoms.

Sport activity levels following ankle fusion.

PURPOSE: Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS: Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION: Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.

Bilateral breast metastases from small cell lung carcinoma: Case report and review of the literature.

Differentiation of primary versus secondary breast cancer can be difficult, with the relative rarity of the latter representing a diagnostic challenge. Here, we present a case of small cell lung cancer with synchronous bilateral breast metastases in a 52-year-old female. There are less than 5 other cases of small cell lung cancer with bilateral breast metastases reported in the literature to date. The breast metastases represented the first clinical and imaging manifestation of malignancy in our case. We present the patient's disease course including multi-modal imaging, histopathologic analysis, and clinical management. We aim to highlight the entity of secondary breast cancer and how multidisciplinary collaboration can help arrive at the diagnosis, which is critical for prognosis and treatment planning in this patient population.

Subchondral insufficiency fracture of the knee: unicompartmental correlation to meniscal pathology and degree of chondrosis by MRI.

OBJECTIVE: To assess the relationship between low- and high-grade subchondral insufficiency fracture of the knee (SIFK) and meniscal tear/type/location, severity of meniscal extrusion, grade of chondrosis, and extent of surrounding edema-like marrow signal intensity. MATERIALS AND METHODS: Our retrospective study included 219 patients with knee pain and SIFK seen on MRI. SIFK lesions were categorized from grade 1 to 4 with a low grade (1 and 2) vs high grade (3 and 4) distinction. Associations between SIFK grade, location, lesion dimensions, edema-like marrow signal intensity, incidence of meniscal tears/type/location, and chondrosis (grade 0 to grade 4), as well as patients' age and weight, were assessed. RESULTS: Our analysis consisted of 115 males and 104 females with 17% of the patients showing grade 1 SIFK, 59% grade 2, 16% grade 3, and 8% grade 4. No chondrosis or low-grade chondrosis was mostly present in patients with low-grade SIFK (68.9%), whereas high-grade chondrosis was mostly present in patients with high-grade SIFK lesions (65.4%) (p < 0.01). Further sub-analysis demonstrated that high-grade SIFK was associated with high-grade chondrosis in the same compartment (p < 0.01) but not in the adjacent compartment. There was a significant difference in the extent of edema-like marrow signal intensity between the two groups, with high-grade SIFK more frequently demonstrating severe edema-like marrow signal intensity compared to low-grade SIFK (p < 0.01). CONCLUSION: High-grade SIFK lesions are associated with unicompartmental high-grade chondrosis.

Heterotopic ossification post COVID-19: Report of two cases.

Heterotopic ossification is often associated with trauma and surgery, and infrequently reported with immobilization due to critical illness. We present 2 patients who developed heterotopic ossification following severe COVID-19 infection. Both patients were middle-aged females who were hospitalized for one month or greater due to COVID-19 requiring mechanical ventilation. Both developed shoulder pain and/or stiffness a few months after discharge, with imaging studies clearly illustrating development of heterotopic ossification around the shoulders. The etiology is unclear, with immobilization and hypoxia being the primary considerations. Physical examination and radiography are essential to diagnosis. Awareness of this complication and early diagnosis may help minimize functional impairment.

Fat embolism in the popliteal vein detected on CT: Case report and review of the literature.

Fat emboli are a common phenomenon, but are rarely detected or reported on extremity CT imaging. We present a case of fat embolus in the popliteal vein in the setting of a femoral fracture. This is the most distal fat embolus described in the literature. There are no guidelines regarding intervention if a fat embolus is detected in a peripheral vein on CT. A review of all the previous cases of peripheral fat emboli is presented for reference.

Relationship between Serum Level of Endocan and Severity of Childhood Asthma.

Endocan is an endothelial cell-associated proteoglycan that is preferentially expressed by renal and pulmonary endothe¬lium. It reflects endothelial activation and dysfunction, this study aimed to investigate the role of Endocan in bronchial asthma and correlate their levels with the severity of asthma. Sixty children with mild and moderate asthma and 20 healthy controls were included in the study and subjected to full clinical examination, Anthropometric measurements, pulmonary function test, CBC and assay of serum level of Endocan using ELISA. A high significant increase in serum level of Endocan was found in all asthmatic children compared with the controls. Significant higher levels were also found in mild and moderate persistent asthma as compared to controls. In all asthmatic children, there was significant positive correlation between serum level of Endocan and PBE count and negative correlation with FEV1 and PEF, and insignificant correlation with serum IgE level. In conclusion; high Endocan level is associated with poor lung functions and severity of asthma. Further studies are needed to validate these data.

The prevalence of congenital C1 arch anomalies.

PURPOSE: To determine the prevalence, radiographic features and reporting rate of, and the association between the congenital anterior and posterior C1 arch anomalies. METHODS: The computed tomography (CT) images of the cervical spines of all patients over 18 years who had CT examinations in our hospital during the study period were reviewed to evaluate for congenital anomalies of the anterior and posterior C1 arches. Radiology reports of the corresponding CT examinations were reviewed to determine the reporting rate of these defects. RESULTS: Of 3273 subjects, 185 (5.65%) had congenital atlas anomalies: 169 isolated posterior (5.16%), 15 combined anterior and posterior (bipartite, 0.46%), and one isolated anterior (0.031%) arch defects. Females had a higher prevalence than males (7.46 versus 4.72%, P = 0.0013). Eighty-three cases (44.9%) of C1 arch anomalies were not reported. The Currarino type A, B, C and E posterior arch defects accounted for 81.6, 8.1, 1.1, and 0.5% of all arch anomalies while type D was not observed. Fifteen patients (0.46%) had combined anterior and posterior arch anomalies (bipartite atlas) versus only one with an isolated anterior C1 defect, indicating a significant association between the anterior and posterior arch defects (P < 0.0001). CONCLUSIONS: Although some types of congenital C1 arch anomalies are rare, type A defects are relatively common radiological findings that are unreported approximately 45% of the time. Based on the significant association between the anterior and posterior arch defects, we propose possible mechanisms for the formation of the bipartite atlas.