Ribbing disease- radiograph to the rescue in an overlooked cause of painful shin

Ribbing disease or multiple diaphyseal sclerosis is a rare clinical entity, which is often confused with many other differential diagnoses when it primarily involves the tibia and fibula. An accurate diagnosis alleviates the need for tissue diagnosis and aids in better clinical management and outcome of the patient. The case report highlights the classical imaging findings, appearance on cross-sectional imaging, and the admirable role of radiographs in diagnosing the entity.

Botchu-Beale accessory ligament of lateral ankle

Variations in anatomy of the tendons and ligaments are not uncommon and cause a diagnostic dilemma. We describe a novel ligament encountered in the ankle extending from posterior inferior tibiofibular ligament to calcaneum. Awareness of normal variant is essential during evaluation of a study.

Multicentric epithelioid hemangioendothelioma of humerus and scapula

Epithelioid hemangioendothelioma (EH) is a rare malignant vascular tumor occurring mainly in the liver and lungs, with bones being a rare site and primarily seen in the adult population. We present a rare case of multicentric EH in the right humerus in an adolescent male, who presented with complaints of pain and swelling in the right shoulder. Radiographs and Computed tomography showed a large expansile lytic lesion in the proximal end of the right humerus with areas of cortical destruction and matrix calcification. On Magnetic resonance imaging, the lesion was predominantly isointense on T1-weighted image, hyperintense on T2-weighted, and Short Tau Inversion Recovery images with prominent flow voids within. On post-contrast sequences, the lesion showed intense heterogenous enhancement with a non-enhancing central necrotic area. Multiple smaller lytic lesions with similar imaging characteristics were also found in the mid and distal shaft of the right humerus and the right coracoid process. Differentials of Telangiectatic osteosarcoma, Giant cell tumor, brown tumors of hyperparathyroidism, and metastasis were considered. Core biopsy revealed that the lesion was an EH. Though the imaging features of EH are non-specific, it may be considered in the differential diagnosis of an expansile lytic bone lesion with no periosteal reaction, showing cortical break and soft tissue component, especially if it is multifocal and multicentric.

Fatty disc: An unusual pattern of disc degeneration

The intervertebral disc is the fibrocartilaginous structure between the endplates of adjacent vertebral bodies, providing support and mobility to the spine. Normally, the disc is isointense on the T1 weighted image (T1WI) and hyperintense on the T2 weighted image (T2WI). Degenerating disc shows loss of hyperintensity on T2WI due to disc dehydration. The development of hyperintensity on T1WI in degenerating disc is unusual. Causes of discal hyperintensity on T1WI include calcification, hemorrhage, melanin, mucin, or fat within the disc. Fat contents in the disc may be rarely seen in degeneration and appear as hyperintense signal on T1WI and T2WI. We, hereby report a case of discal hyperintensity on T1WI and T2WI due to fatty degeneration of the disc.

Mueller Weiss syndrome, a less elucidated and unusual cause of midfoot pain: A case report

Mueller Weiss Syndrome is a rare, under-diagnosed cause of chronic mid foot pain despite having well-described imaging features. It is historically described as spontaneous adult-onset osteonecrosis of the navicular bone. The disease commonly affects bilateral navicular bones in women in the fifth decade of life. Nearly a century after its first description as a disease entity, the exact etiopathogenesis is still not well understood. From a radiographic point of view weight-bearing radiographs of the foot remains the mainstay in diagnosis. Characteristic imaging findings include the lateral collapse of navicular, dorsomedial subluxation of the remnant navicular, and lateral deviation of the talus (hind-foot varus). Progressive disease leads to pes planus and secondary osteoarthritis of the talonavicular joint with or without the involvement of other midfoot joints. Severe disease may show “listhesis navicularis” and talo-cuneiform neo-articulation. Computed tomography and magnetic resonance imaging can be used as adjuncts, especially to detect changes in the initial stage of the disease and early osteoarthritic features.

Magnetic resonance imaging features of large joint tuberculous arthritis

Objectives: Large joint monoarticular tuberculous involvement is rare. It may not be associated with classical clinical features. Hence, it is difficult to differentiate from other conditions similarly involving the large joints. Our study aimed to study the characteristics of large joint monoarthritis on magnetic resonance imaging. Material and Methods: We reviewed the radiology database for large joint tubercular arthritis cases over 2 years. In total, there were 21 patients. Male: female ratio was 11:10. The mean age was 34.14 ± 15.82 years with a range of 8–57 years. We diagnosed tuberculosis (TB) based on histopathological examination or response to antitubercular therapy. Results: Knee was most frequently involved (47%; n = 10) followed by wrist and elbow in 3 patients each (14.28%). Concomitant active pulmonary TB was absent in all of our patients. Grade I synovial thickening was seen in eight patients, Grade II in four, and Grade III in seven. It was uniform in all the cases. Grade 1 bone marrow edema was seen in 06 patients, Grade III in 13, and none in 02. There was soft-tissue edema in 12 patients and soft-tissue collection in 2. Bone erosions were seen in 16 patients with rim enhancement in nine patients. Central erosions were seen in eight, while central and peripheral erosions in eight. On T1-weighted images, the signal intensity was hyperintense 10 and isointense in 11 patients. While on T2-weighted images, it was hyperintense in 10, isointense in nine, and hypointense in two patients. Conclusion: Large joint monoarticular tuberculous arthritis can present variably. Large erosions with rim enhancement, the signal intensity of synovium on T1 weighted and T2 weighted, uniformity of synovial thickening, and enhancement pattern of abscesses can help make a diagnosis.

Multimodality imaging in shoulder arthroplasties Part 2: Immediate pre- and intra-operative imaging and imaging of early and late complications – A pictorial review

Shoulder arthroplasty imaging requires a thorough understanding of surgical techniques, biomechanics involved during and after the joint replacement surgery and complications unique to shoulder arthroplasties. One may believe that imaging of complications requires excessive complex imaging modalities such as MRI or nuclear imaging. However, contrary to such beliefs, one can diagnose such complications mostly on radiographs. We will describe advances in immediate pre-operative imaging and utility of imaging to diagnose shoulder arthroplasty- related complications in part 2 of our two-part pictorial review series.

Isolated infraspinatus atrophy in elite volleyball player- Understanding the biomechanics, imaging and outcome

Over 800 million people worldwide play volleyball, either recreational or competitive. Even though all throwing athletes suffer from upper extremity injuries caused by overuse, volleyball additionally involves certain prototypical throwing biomechanics, not seen in other overhead sports. Complex biomechanics and the balanced interplay between the glenohumeral and scapulothoracic muscles ensure velocity and torque displacement in spike and jump-serve maneuvers (formerly known as smash) which are exclusive to volleyball. In this case report, we have described in detail the entity of isolated infraspinatus atrophy secondary to suprascapular nerve neuropathy.

Imaging in a case of classic Trevor’s disease

Trevor’s disease, also known as dysplasia epiphysealis hemimelica, is a rare developmental bone dysplasia, characterized by benign osteocartilaginous overgrowth pathologically indistinguishable from osteochondroma. The lesion arises from epiphysis more so on the medial aspect of long bones resulting in painless or painful deformities and limb length discrepancies. Imaging plays an important role in diagnosis as the features are characteristic in an appropriate demographic background. We report a case of Trevor’s disease in a 2-year male with multifocal involvement and characteristic imaging findings.