I Don't Think This Is Gout .

Osseous sarcoidosis is a well-recognized manifestation of systemic sarcoidosis; however, its radiological natural history is poorly described. A 29-year-old man presented with pain, swelling, and erythema at the site of a recent minimal-trauma fracture of the right index finger proximal phalanx.

Triangular fibrocartilage complex injury: outcomes of operative and non-operative management.

OBJECTIVE: The prevalence TFCC injuries has increased over time. However, there remains a lack of understanding of its natural history. Along with the paucity of evidence on treatment options, there is lack of consensus on how best to manage them. This is a retrospective study with subgroup cohort analysis, examining variables and management options associated with patient-reported disability and pain. METHODS: Patients from a metropolitan health network who have been referred for Magnetic Resonance Imaging (MRI) of the wrist between 2010 and 2019 and identified to have TFCC injury, were followed up to determine patient-reported outcomes. Disability of arm shoulder and hand scores (DASH) and visual assessment pain scale (VAS) were used to measure disability and pain respectively. An 'excellent' DASH and VAS scores were defined as ≤10 and ≤2, respectively. RESULTS: One hundred and twenty-four patients met the inclusion criteria and consented to participate in this study. There were 53 patients with excellent DASH score, 95 excellent VAS score and 51 excellent outcomes at mean follow-up of 75.5 months (Range: 5-402.8 months). Concomitant pathology and surgical management were less likely to have excellent DASH and VAS scores, while traumatic aetiology and smoking were less likely to have excellent VAS score. Age was not predictive of excellent DASH or VAS score. CONCLUSIONS: Surgical management of TFCC injuries were associated with worse outcomes than if they were left alone. Smoking cessation is a patient-modifiable risk factor that may help improve outcomes.

Hepatic GIST metastases: an illustrative case series.

Gastrointestinal stromal tumours (GISTs) are uncommon mesenchymal tumours affecting the gastrointestinal tract. The liver is one of the most common sites for metastatic disease from GISTs and may exhibit a variety of CT and MR imaging appearances. These imaging features can vary prior to and following treatment with tyrosine kinase inhibitors. We report on the spectrum of imaging appearances of hepatic GIST metastases on multiphase contrast CT imaging and hepatocyte-specific contrast enhanced MR. To our knowledge, there are no published series specifically focusing on the appearances of liver metastases from GISTs. An awareness of the protean appearances and pitfalls on CT and MRI of hepatic GIST metastases, prior to and at different times along the treatment pathway, will assist in early diagnosis of liver metastases, accurate assessment of tumour response and detection of recurrent metastatic disease.

Vascular disorders of the gallbladder and bile ducts: Imaging findings.

Vascular disorders of the gallbladder and biliary tree are many and varied. In the acute setting, the clinical presentation of vascular conditions such as hemorrhagic cholecystitis and gangrenous cholecystitis are non-specific and rely on imaging for diagnosis and triaging for emergent surgery. These hemorrhagic and ischemic complications of acute cholecystitis are uncommon but potentially fatal. Hemorrhage into the gallbladder and biliary tree, from other causes, may itself result in acute cholecystitis. Knowledge of vascular anatomy of the gallbladder and biliary tree is essential for surgeons to prevent significant operative bleeding complications, particularly in laparoscopic cholecystectomy. The unique venous drainage of the gallbladder and biliary tree, with their connections to the portal venous system, lends itself to less well-recognised vascular phenomena such as gallbladder varices, portal biliopathy, and gallbladder bed perfusion abnormalities.

Patterns of enhancement in the hepatobiliary phase of gadoxetic acid-enhanced MRI.

A variety of patterns of enhancement of liver lesions and liver parenchyma is observed in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. It is becoming increasingly apparent that many lesions may exhibit HBP enhancement. Much of the literature regarding the role of gadoxetic acid-enhanced MRI in characterising liver lesions is dichotomous, focusing on whether lesions are enhancing or non-enhancing in the HBP, rather than examining the patterns of enhancement. We provide a pattern-based description of HBP enhancement of liver parenchyma and of liver lesions. The role of OATP1B3 transporters, hepatocyte function and lesion composition in influencing patterns of HBP hyperintensity are discussed.

Hepatic disorders associated with exogenous sex steroids: MR imaging findings.

OBJECTIVE: To describe the MRI findings of the effects of exogenous sex steroids on the liver. FINDINGS: Estrogens, progesterone and synthetic testosterone are exogenous sex steroids that may result in a variety of liver diseases, including tumour formation and vascular disorders. These hormones are mainly administered in the form of the oral contraceptive pill (OCP) and anabolic steroids. Both are implicated in hepatic adenoma formation. The HNF-1α-mutated and inflammatory adenoma subgroups are more commonly seen in association with the OCP whereas there is an increased incidence of the ß-catenin positive subtype with anabolic steroid use. Furthermore, anabolic steroids are associated with hepatocellular carcinoma resulting from malignant transformation of ß-catenin positive adenomas. The oral contraceptive pill may also induce vascular disorders within the liver, some of which are related to the prothrombotic effect of the hormones, such as hepatic and portal vein thrombosis. Other hepatic vascular abnormalities resulting from exogenous sex steroids include veno-occlusive disease and peliosis hepatis.

An unusual cause of diffuse pulmonary haemorrhage.

INTRODUCTION: Diffuse pulmonary haemorrhage is a potentially life-threatening complication of a variety of conditions. Tumours, including angiosarcoma lung metastases, are an unusual cause of pulmonary haemorrhage. METHODS: Report of a case. RESULTS: This case describes a 38-year-old previously healthy male who presented with chest wall bruising followed by haemoptysis and a cerebellar haemorrhage. The patient developed diffuse pulmonary haemorrhage. A biopsy of the chest wall lesion indicated a haematoma and an open-lung biopsy suggested the diagnosis of vasculitis. The patient died within 3 months after initial presentation and an autopsy revealed a chest wall angiosarcoma with pulmonary and cerebellar metastases. CONCLUSION: Pulmonary angiosarcoma metastases should be included in the differential diagnosis of diffuse pulmonary haemorrhage, especially in a young, previously healthy patient with normal renal function, particularly as the pathological diagnosis may be difficult and even misleading.

Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis.

The role of MR in the early diagnosis of acute osteomyelitis is well known. In the context of florid cellulitis, abnormalities of marrow signal are not uncommon, although they are often non-specific. Marrow oedema and enhancement in the context of deep cellulitis might reflect either reactive marrow oedema or true osteomyelitis. More specific signs lend favour to the diagnosis of osteomyelitis: these include focal bone destruction, periosteal reaction and sequestra. The observation of an extramedullary fat-fluid sign is also a specific sign for osteomyelitis, as illustrated in the following case report. This sign is an indication of cortical breach and, thus, in the setting of infection and in the absence of trauma confirms the presence of osteomyelitis. To our knowledge, this additional specific sign of osteomyelitis has not been previously reported on MR.

Intracranial Tc99m MDP uptake in Sturge-Weber syndrome.

A case of intracranial extraosseous 99mTc MDP uptake is presented, which was found on CT to be due to dystrophic gyral calcification characteristic of Sturge-Weber syndrome (SWS). The imaging characteristics of SWS are described. The possibility of extraosseous MDP uptake should be considered when unusual or atypical 'hot spots' are seen on bone scanning.