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15M Runner with "Hip" pain

No Hip Injury. Instead, subacute partial tear of the Sartorius at its ASIS origin (note reactive BME). At the cranial margin of the FOV we can see that he previously partially avulsed the ITB at its iliac tubercle origin (residual bright signal in defect but minimal residual BME).  Just demonstrating the AIIS with the direct head R Femoris origin.

71M with arthritis NOS

Need diagnostic help.  71 yr old Indian Male with arthritis, NOS.  There is normal BMD, acro-osteolysis, acquired fusion of the base of the right 2nd and 3rd toe, JSN and erosions right 2nd and 3rd MTPJ  and fusiform swelling at the right middle finger PIP.  I favor psoriatic arthritis, but haven't seen it look quite like this.  Agree or no?  DDx???

Anatomy Question Re an Accessory Ulnar Wrist Ossicle

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This patient fell 1 week ago, known distal radial fracture, ordered by hand surgeon to evaluate possible "volar Barton fracture".  There is no fracture at the base of the thumb metacarpal.  My question is about the small, smooth ossicle adjacent to the base of the triquetrum.  This is 4.5 mm distal to the ulnar styloid.  Is this (A) traumatic displacement of an Os Triangulare...and, if so, what is it embedded in, what is torn?, or is this a (B) Os Hypotriquetrum (something listed in Wikipedia that I have never noticed)?

50-year-old with Thumb Mass

Thumb mass

50-year-old man with pain and swelling of the thumb. ED walk-in. History of minor thumb trauma two weeks ago. By clinical exam in the ED and labs, no signs of infection.

Radiographs

MRI

T1 and T2FS

T1 and T2FS

DWI and ADC

DCE shows late enhancement

T1FS with contrast

Impression

Atypical infection or neoplasm? Other differential diagnoses?

59F with suspected PTT tear

This is an anatomy question.  Is the segment indicated by the white arrow an accessory slip of the PTT or the plantar navicular-medial cuniform capsule?  The red arrow indicates the main insertion onto the medial pole navicular. References mention accessory slips inserting onto the cuneiforms and 2nd-4th MT bases.  I'm not clear if that includes the base of the medial cuneiform.  Do you know?

59F with symptoms of impingement to evaluate rotator cuff tear

Is this a Supraspinatus or Infraspinatus tendon tear?
Exaggerated external arm rotation is a bit confusing in the Cor and Sagittal plane.
Does the BLO help?  Click here:Yes, because the BLO is in plane with the long axis of the Infraspinatus, which is an external rotator and  appears taut in the BLO images with the arm in external rotation.
The tear is at the posterior insertion of the Supraspinatus. 

58F Chronic Refractory Hip Pain

There is G Minimus Tendinosis and High grade insertional tear with contiguous partial tear of the Vastus Lateralis. This looks similar to the contiguous delaminating type tear we see in athletic pubalgia at the Rectus Abdominis-Adductor Longus aponeurosis.  Is there a common aponeurosis in this location?  I've seen this many times.

47F referred for evaluation of soft tissue mass

The referrer didn't even provide history of Tibialis Anterior tear or repair, though we see suture artifact along the course of the ATT and anchor implantation of the distal tendon into the medial cuneiform.  I was rather convinced the mass looked like a muscle hernia at the distal MT junction when I reported it Friday---but on review, I'm not certain.  What do you think?  Also, outside pre-op MRI (shared by Erin Alaia, MD) shows an ATT split at the level of the distal tibia with marrow edema in the midfoot, but the distal tendon looks intact---I cannot imagine why they re-implanted the ATT insertion in the medial cuneiform. 

16 y/o dancer with hip pain.

16 y/o dancer with hip pain. This lesion is away from the "stellate lesion" pseudodefect at the superior aspect of the acetabulum. She also has one of those shown in the last coronal images.

This anterior lesion is surrounded by medullary bone marrow edema.

What would you call it? I know what I called it although supposedly exceedingly rare from the literature.

Here is the pseudodefect in the same hip.

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Phillip Tirman MD
Renaissance Imaging Center Westlake Village

Two Dole Drive

Westlake Village, CA 91362

Tel: 818-575-8066