History (HX): Female 15 yr
Findings:
There is a large destructive mass at distal femoral metadiaphysis. Cortical destruction and extensive periosteal reaction with sunburst appearance are present. The mass is in close proximity with neurovascular bundle.
Diagnostic (DX):
Malignant small round cell tumor more probably Ewing sarcoma (proved)
History (HX):
Paresis and pain of right upper extremity after trauma (2 months ago) and fracture of right clavicle
Male 74yr
Findings:
A displaced bone fragment is pressing on the retroclavicular part of the Brachial plexus. Narrowing of the costoclavicular space is seen with impingement on the Brachial plexus by the malunited fragments
Diagnostic (DX):
Fractured clavicle with Brachial plexus injury
Discussion:
Clavicular fractures are occasionally responsible for lesions of the Brachial plexus. The symptoms are usually delayed and due to compression by hypertrophic callus, nonunion or a subclavian pseudo aneurysm
History (HX):
Metastatic adenopathy in left axillary region with no detectable mass in US and mammography
Female 47yr
Findings:
A 18 x 14 mm mass with lobulated, irregular margin at retroareolar region of left breast high signal on T2WI , low signal on T1WI and rapid washout enhancement (type 3 time intensity curve)
Diagnostic (DX):
Invasive ductal carcinoma in left breast
Discussion:
MR images can be helpful in identifying breast cancer that is mammographically and sonographically occult such as this case with known metastatic left axillary adenopathy and negative mammography and US
History (HX):
Pain and incomplete paralysis of right limb following trauma Male 22 yr
Findings:
(Dilated nerve root sheath following root avulsion)
Sagital T2WI shows prominent intraforaminal CSF-filled space without characteristic hypointensity of exiting nerve root
Diagnostic (DX):
Multiple right sided nerve root avulsions
(Brachial plexus traction injury avulsion pseudomeningocele)
Discussion:
Lateral meningocele mimics pseudomeningocele but contains neural elements
History (HX):
Palpable mass and pain during a few months, Male 39 yr
Findings:
Large well-marginated solid and cystic mass in lower abdomen and pelvis behind the urinary bladder and above the rectum suggestive of a retropritoneal mass.
The solid components of the mass shows marked enhancement on post-Gd images.
Diagnostic (DX):
Low grade spindle cell sarcoma in favour of schwannoma (proved)
History (HX):
Pain and swelling of the right elbow and right ankle / clinical history of hemophilia, Male 13 yr
Findings:
-Hemosiderin deposing in synovial membrane around these joints low signal on both T1W and T2WI
-Subchondral and intraosseous cysts. Most of them high signal on T2WI and low signal on T1WI compatible with nonhemorrhagic fluid and some are low signal on both T1WI and T2WI representing fibrotic tissue and hemosiderin
-Small cortical erosions
Diagnostic (DX):
Hemophilic arthropathy
Discussion:
The differential diagnosis of synovial-based lesions hypointense on T2WI includes PVNS, GCT of tendon sheath, synovial chondromatosis, hemophilic arthropathy, amyloid , longstanding RA and siderotic synovitis
History (HX):
Palpable mass at right buttock and severe local pain history of fibromatosis at distal right thigh, Male 21 yr
Findings:
Relatively large mass at right buttock (within the gluteus maximus) with irregular margins which contains low signal foci on both T1WI and T2WI fs
Diagnostic (DX):
Fibromatosis
Discussion:
The fibromatoses are a group of soft tissue lesions characterized by proliferation of fibroblasts in an abundant collagen matrix and are prone to recurrence after surgery
History (HX):
Pain, swelling and irritation following IM injection (vaccination) at left thigh at birth, Female 3 months
Findings:
Thigh MRI shows, a large fluid-filled cystic lesion within the quadriceps femoris muscle with internal septations, perilesional edema and thick irregular enhancing wall and enhancing septations.
No evidence of osteomyelitis
Diagnostic (DX):
Abscess formation (proved with surgical drainage)
History (HX):
Trauma during sport, Male 36yr
Findings:
Axial T2WI show edema at anterior fascial compartment. Absence of the biceps tendon at the level of the radial head (its normal distal attachment site) is seen and at upper axial cuts an abnormally thickened and retracted biceps tendon is seen.
Diagnostic (DX):
Biceps tendon tear
Discussion:
The biceps tendon has two muscular components proximally consisting of a short head attaches to the coracoid process and a long head that attaches to the superior glenoid labrum. These two muscles fuse at upper portion of the arm and have a single distal attachment at the radial tuberosity
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