Medial Malleolus Ossicle

41 yr old male presented with pain and no swelling. Xrays show apparent bony injury  of medial malleolus with no soft tissue swelling. Medial malleolus ossicle is likely . It is bilateral in 25% population. General incidence though not known may be around 15% adults and more common on lateral malleolus.  Case Submitted by Dr MGK Murthy.

 

An accessory, distal focus of epiphyseal ossification may develop in either malleolus. These foci are not anatomically separate entities, even though they appear to be radiographically. They usually are asymptomatic. However, they may be injured, either acutely or chronically. The diagnosis of such injury by conventional radiography is limited. Bone scintigraphy may be positive if there is a stress fracture.

  

Incidental Findings -Dilemma

According to an article published March  in the Archives of Internal Medicine - "More often than not, incidental findings do more harm than good, leading to unnecessary imaging and excessive angst". According to me this is debatable. Lot of times we radiologists are referred scans for example ureteric calculus and we point out lytic lesion in the vertebrae or bulky adrenal or some nodules in the lung base which point towards the diagnosis which was previously unsuspected. Further, i disagree with the comment made by the authors- "non-indicated physiology in imaging may be better off behind a dark screen rather than seen as a free screen". Think of us radiologists as analogous to crime scene investigator, you cannot just ask me to look at one aspect and ignore all other incidental findings. On the other hand it is one of the advantages of an expert radiologist reading a study that he can report incidental unsuspected findings as well.  

Another persepctive of the article is available here-AIM: Should radiology ignore incidental findings?

Fibrous Cortical Defect Metacarpal

10yr old boy history of fall, shows cortical lucency of 3rd metacarpal

Teaching point by Dr MGK Murthy.

• Both non-ossifying fibroma (fibroxanthomas) and fibrous cortical defects are composed of spindle shaped fibroblasts in a cartwheel pattern with scattered giant cells, foam cells and collegan along with abundend hemosiderin, cholestrol christals in the cytoplasm of fibroblasts.
• Very common incidental radiographic lesion (caffey reported 36 % in population) in asymptomatic children with slight male predominance.
• Usually present 4 to 8 years age, with peak incidence 10 to 15 years.
• 90 % occur in tubular long bones with commonest sites being, distal femoral, proximal and distal tibial and around the knee with upper extremity being an uncommon site. however cases are reported in the innominate bone, clavical, skull, scapula, mandible and small bones of hands and feet.
• Typically metaphyseal and close to physeal plate.
• The FCD arises within the cortex where as NOF arises eccentrically within the medullary cavity, with multiplicity being moe common with FCD.
• Both arise from the posterior wall of the tubular bone and involvement of medial rather than lateral osseous surface is characteristic.
• May involute and disappear or persist into adult life with epiphyseal location rare.

D/D :- Include chondromyxoid fibroma, fibrous dysplasia, osteoid osteoma, bone abscess, periosteal chondroma, avulsive cortical irregularity, periosteal desmoid fibromatosis, desmoplastic fibroma, cortical avulsive injury.

The presence of extraskeletal congenital anomalies like cafe-as-lait spots, mental retardation, hypogonadism or cryptorchidism, cardiovascular malformations in association with multiple nonossifying fibroxanthomas constitute the  Jaffe-Campanacci syndrome.

Pseudoepiphysis Index Finger Metacarpal Base

" Phylogenetically, there are potential epiphyses at both the proximal and distal ends of the tubular hand bones.... A persistent expression of the distal epiphysis of the thumb metacarpal is called a pseudoepiphysis. The pseudoepiphysis appears earlier than its standard counterparts, then fuses rapidly. BY the sixth or seventh year it has been incorporated and is inconspicuous. Pseudoepiphysis have also been noted at the proximal ends of the finger metacarpals, usually of the index finger. Its only clinical significance is that it must be differentiated from an acute fracture." -- Rockwood and Green, Fractures in Children. 4th Ed.1996, p326.

Teaching Point submitted by - Dr MGK Murthy.

Billboard

I was driving sleepily along heavy-traffic in EDSA when I saw this billboard...click the picture to see the bigger version.

I don't know if this was intended to be a joke or something so EDSA drivers don't get to sleep behind the wheels. Photoshop or surgery?

Teleradiology Providers- IRIA 2011

This is one of stills from IRIA 2011, the largest Indian Radiology congress, where Sumer Sethi was invited as faculty to present Asian -African perspective-Teleradiology. According to him teleradiology represented a paradigm shift in the way radiology is practised.

Teleradiology Providers- DD News

Our company has been recently covered by DD News as it was female oriented programme, they focussed on positive for ladies as they can work from home with teleradiology. Featured in this video are our main Radiologists Dr Sumer Sethi and Dr Priya Chudgar.  Being one of the pioneers of this business in India, this coverage by leading official news channel in the country is another feather in the cap of Prime Telerad Providers (P) Ltd-Teleradiology Providers.