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

14 Y?O with months history of knee buckling and swelling

Here is another case that I am hoping Dr. Gorbachova will comment on. 14 y/o M with "months history" of swelling, instability and buckling. No history of specific antecedent trauma.

Looks in the spectrum of osteochondritis dissecans vs osteochondrosis to me. What do you think? Simultaneous patella and medial tibial plateau? One of each? Neither?

Another great article btw: https://pubs.rsna.org/doi/pdf/10.1148/rg.2018180044

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Phillip Tirman MD
Renaissance Imaging Center Westlake Village

Two Dole Drive

Westlake Village, CA 91362

Tel: 818-575-8066

35M runner with chronic hip pain MRI 2016 and Now

From Feb 2016. Reported as Transient Osteoporosis / Subchondral Fracture. Follow-up was recommended to "r/o progression to AVN". WHAT???? New MRI today shows normal marrow signal. White arrow, might hallucinate residua of old healed fracture, or not.  No AVN.  Same anterosuperior labral tear. What is the current concept of TOP? Is the "Party Line" that it is subchondral fracture?  Conference talk suggests that, but I can't see that stated in the literature.  Some literature points to "potential risk of developing AVN" but I cannot find a single case of progression of TOP to AVN...what's THAT about??? Who can tell us what the truth is?