Notes

Case document associated with ipsilateral humeral canal fracture as well as shoulder dislocation handled through closed lowering then intramedullary nailing.
We aimed to clarify differences in femoral morphology associated with post-hip fracture knee pain (PHFKP).

Medical records and radiographic examinations were retrospectively reviewed to determine the relationship between PHFKP development and femoral morphology. Leg length discrepancy (LLD) and neck-shaft angle discrepancy (NSAD) were measured from hip radiographs.

202 were enrolled, of whom 64 (31.7%) developed PHFKP. The PHFKP group showed more varus NSA. Intertrochanteric femoral fractures (γ-nail or CHS) displayed a more varus NSA.

Femoral morphology (varus NSA) may be involved in the development of PHFKP.
Femoral morphology (varus NSA) may be involved in the development of PHFKP.
The purpose of this study was to determine whether alcohol use disorder (AUD) patients undergoing reverse shoulder arthroplasty (RSA) have increased 1) lengths of stay (LOS); 2) complications; and 3) costs.

The study identified 19,168 patients in the study (n=3198) and control (n=15,970) cohort. In-hospital LOS, 90-day complications, and costs were assessed.

AUD patients had significantly longer LOS (3- vs. 2-days,
<0.0001), higher9 0-day medical complications (49.59 vs. 14.81%;
<0.0001), and 90-day costs of care ($18,763.25 vs. $16,035.49,
<0.0001).

The study is useful as it can allow healthcare professionals to adequately counsel these patients.
The study is useful as it can allow healthcare professionals to adequately counsel these patients.Pancreatic fluid collections (PFC) are notorious for their extension beyond the normal confines of the pancreatic bed. This distribution is explained by dissection along the fascial planes in retroperitoneum due to the digestive enzymes within the PFC. In genitourinary track, PFCs have been described to involve the kidneys and the ureters. We report a case of severe acute necrotizing pancreatitis in a 28-year-old male, chronic alcoholic, who on readmission developed features of cystitis. The urine was turbid but did not show significant bacteriuria. Close location of the PFC near the urinary bladder (UB) prompted evaluation of urinary lipase and amylase. Elevated urinary enzyme levels suggested a Pancreatico-vesical fistula, conclusive demonstration of which was established by CT cystography. Percutaneous drainage of the necrosum and stenting of pancreatic duct led to spontaneous healing of the pancreatico-vesical fistula. Our case reiterates the remarkable property of pancreatic enzymes to dissect the fascial planes which is demonstrated by decompression of PFC via UB causing spontaneous Pancreatico-vesical fistula. Further, presence of main pancreatic duct fistulization should prompt endoscopic-guided stenting to obliterate the communication with the fistula and accelerate healing.Parathyroid cyst is a rare clinical entity and often presents as a diagnostic challenge, especially when presents in conjunction with a coexistent parathyroid adenoma. Patient with primary hyperparathyroidism had presented with a localised left inferior parathyroid adenoma with a coexistent right inferior parathyroid cyst which was initially missed on routine ultrasound and sestamibi scan. Suspicion of right inferior thyroid cyst was raised on ultrasound done by a dedicated parathyroid ultrasonologist. Right inferior thyroid cyst was confirmed to be parathyroid cyst on histopathological examination. Parathyroid cysts are seldom picked on sestamibi due to compressed parathyroid tissue present only at the periphery of the cyst. Hence, use of adjunct anatomical imaging like ultrasound, CT scan or MRI is worthwhile to reduce chances of missing hyperfunctional parathyroid tissue, which can eventually lead to revision surgery for persistent primary hyperparathyroidism.Intracranial haemorrhage after supra-tentorial craniotomies can occur in a typical pattern and location which may suggest the diagnosis of remote cerebellar haemorrhage (RCH) which is quite a rare occurrence. The 'Zebra Sign' refers to a pattern of hyperdensity indicative of blood and hypodensity indicative of normal cerebellar parenchyma in a curvilinear, stripe-like fashion along the cerebellar folia and is a characteristic imaging finding in RCH. RCH in general doesn't require surgical treatment, however in cases of significant hydrocephalus or progressive deterioration of consciousness surgical treatment may be warranted. The knowledge of this condition is important as it can pre-empt unnecessary further investigations and biopsy. Although imaging appearance may be striking, close imaging follow-up and clinical monitoring are often enough for the management of this entity.Herniation of brain parenchyma outside its normal enclosure (also known as encephalocele) has long been known to occur at certain classic sites and is classified accordingly. With widespread use of modern neuroimaging, the previously unknown atypical and rare sites of encephalocele have now been identified. Brain herniation into a dural venous sinus is one such recently described entity with case reports extending only upto the earlier part of this decade. With no definite clinical symptomatology, imaging is crucial to diagnose this lesion accurately and differentiate it from the more familiar entity in this region of the brain, the arachnoid granulations. Also known as occult encephalocele, focal brain herniation into dural venous sinus has few specific imaging features and characteristic sites. We report a case of a 21-year-old man with partial seizures in whom MRI of the brain revealed focal herniation of the normal temporal lobe parenchyma into the left transverse sinus and discuss the key imaging features and pathophysiology of this entity.An intraspinal bronchogenic cyst is a rare but important cause of compressive cord myelopathy, commonly seen in the cervicothoracic spine. We report a case of a 30-year-old female, presented with complaints of neck pain and progressive weakness of the extremities. The magnetic resonance imaging of the cervical spine revealed an intradural extramedullary, well-defined, multiloculated, cystic lesion in the upper cervical canal extending from the C2 to C5 vertebral levels. To our knowledge, only 11 cases of spinal bronchogenic cysts have been reported in the literature so far. We discuss the rare location of this unusual lesion, possible embryological reasons, and the overall surgical outcome.Perineural cysts are usually described in Lumbosacral region and are uncommonly seen in cervical spine. These are mostly asymptomatic, with only a few cases of symptomatic cervical perineural cysts. No previous case report of perineural cyst causing C8/T1 radiculoneuropathy mimicking clinically as Carpal tunnel syndrome is reported in the literature. We report a case of elderly female who was operated for presumed Carpal tunnel syndrome. However, her symptoms did not improve. The MRI of the patient revealed presence of perineural cysts at the level of C8/T1 exiting nerve root, compressing it and causing the symptoms. We present the clinical, nerve conduction study and radiological presentation of cervical perineural cyst mimicking Carpal tunnel syndrome in this patient.Avulsion injuries of adductor frequently involve the proximal origin. We report the first case of avulsion fracture of adductor magnus at its insertion and discuss the relevant anatomy.Melorheostosis is an uncommon mesenchymal dysplasia manifesting as regions of sclerosing bone with a characteristic flowing candle wax appearance. We describe here a rare presentation of melhoreostosis with the intra-articular extension of the disease in the knee joint and causing medial patellar impingement.The COL4A1 gene (COL4A1) plays an important role in vascular basement membrane function and pathogenic mutations have been reported in mice and humans. The gene is expressed mainly in the human brain, eyes and kidneys. Pathogenic mutations result in a vast array of manifestations that can present throughout life including the foetal period. We present a case of an 11-year-old girl with right hemiparesis, congenital cataracts, epilepsy and magnetic resonance imaging (MRI) brain findings with a pathogenic COL4A1 mutation. Many of her clinical features are similar to those of a non-genetic cause of cerebral palsy highlighting the difficulties and delays in making this genetic diagnosis.
To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions.

113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC).

Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US 0.98 vs 0.90 (Difference = 0.08,
= 0.02). Elastoies. Elastography score is a better parameter as compared to strain ratio.Respiratory distress is one of the leading causes of neonatal morbidity and mortality. Factors such as gestational age at birth, pulmonary maturity, and congenital factors are peculiar to this demographic. Clinical evaluation accompanied by chest radiography is the standard protocol for evaluating the underlying causative factors. Knowledge of the radiographic appearances of various pathologies and associations with certain congenital factors is quintessential for radiologists and primary neonatal care providers to steer the management in the right direction.
Our objective was to investigate the accuracy of quantitative diffusion-weighted imaging (DWI) to determine the histopathologic diagnosis of pediatric head and neck lesions.

This retrospective study included 100 pediatric patients recently diagnosed with head and neck tumors. All patients underwent preoperative conventional magnetic resonance imaging (MRI) and DWI. Each lesion was evaluated according to signal characteristics, enhancement pattern, and diffusivity. The average apparent diffusion coefficient (ADC) obtained from each tumor was compared to the histological diagnosis of benign, locally malignant, or malignant categories.

Our retrospective study showed a significant negative correlation between average ADC and tumor histopathologic diagnosis (
< 0.001,
= -0.54). The mean ADC values of benign, locally malignant lesions, and malignant tumors were 1.65 ± 0.58 × 10
, 1.43 ± 0.17 × 10
, and 0.83 ± 0.23 × 10
mm
s
, respectively. The ADC values of benign and locally malignant lesions were overlapped. We found a cut-off value of ≥1.19 × 10
mm
s
to differentiate benign from malignant pediatric head and neck masses with a sensitivity of 97.3%, specificity of 80.0%, positive predictive value of 94.7%, and negative predictive value of 88.9%.

Diffusion-weighted MRI study is an accurate, fast, noninvasive, and nonenhanced technique that can be used to characterize head and neck lesions. DWI helps to differentiate malignant from benign lesions based on calculated ADC values. BSJ-03-123 in vitro Additionally, DWI is helpful to guide biopsy target sites and decrease the rate of unnecessary invasive procedures.
Diffusion-weighted MRI study is an accurate, fast, noninvasive, and nonenhanced technique that can be used to characterize head and neck lesions. DWI helps to differentiate malignant from benign lesions based on calculated ADC values. Additionally, DWI is helpful to guide biopsy target sites and decrease the rate of unnecessary invasive procedures.
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