Cervical Rib

Cervical Rib An interesting and significant case we’ve come across is Cervical Rib. Cervical Rib is more often than not, an asymptomatic abnormality affecting .5% of the population. It is more common in females, and arises from the seventh cervical vertebrae. These X-rays represent 3 different cases of Cervical Ribs (AKA, Supernumerary Rib or Accessory Rib). Always remember to mention the presence of Cervical Ribs if present on cervical spine x-rays and if visualized on chest x-rays. Cervical rib is the most important anatomic rib…

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Madelung Deformity Of Wrist Xray

Madelung Deformity Of Wrist Xray A Madelung deformity was first described in 1878 by the German surgeon, Otto Willhelm Madelung as a developmental abnormality of the wrist. The madelung is often a congenital deformity manifesting 10-14 years (autosomal dominant – variable penetrance). This condition can be an acquired consequence of trauma to the growth plate and is more common among females. You can see from the X-ray that there is a premature closure or defective development of the ulnar third of the distal epiphysis of…

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Stress Fracture Xrays

“The eye will not see what the brain doesn’t know.” There are two types of stress factors, and given the severity of risk factors involved, it’s important that you train your eye to recognize what you should already know. First and foremost, you must differentiate each type of stress factor in order to interpret the diagnosis. Stress Fracture Xrays 2 Types: Stress Fracture Insufficiency Fracture = Normal Stress on Abnormal Bone Fatigue Fracture = Abnormal Stress on Normal Bone Stress fractures are microscopic fractures which typically…

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Supracondylar Process

Supracondylar Process (AKA Supracondylar Spur, Supratrochlear Spur, or Avian Spur) is located along the distal anteromedial humeral cortex, and is an anatomical variant present in 1% of the population. Most patients are asymptomatic, so it’s important to spot this condition as it can cause serious issues including, Median Nerve Compression (supracondylar process syndrome) and/or Brachial Artery Compression. In a read like this, consider the following: ~5 cm proximal to and pointing towards the medial epicondyle of the humerus (as opposed to an osteochondroma which points…

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AC Joint Separation

What’s the number one rule I tell myself in reading scans? “The eyes will not see what the brain will not know.” That’s precisely why radiologists are equipped to read scans versus in any other profession. It is not simply enough to look at what’s in front of you; you must read the whole story and the context in order to better understand it and treat it. Here’s a breakdown of an AC Joint Separation scan.                  …

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Elbow Effusion and Radial Head Fracture X-ray

What are the most effective ways to spot abnormalities in an X-ray of this type? Always look for the fat pad signs. Fat pad signs in the elbow are almost always abnormal, so it’s important not to overlook them. Below is a list of fat pads present in this X-ray, inevitably factoring into the patient’s diagnosis. Uplifting of the Anterior Fat Pad (Spinnaker Sail Sign) = Fracture Positive Posterior Fat Pad Sign = Fracture Positive Fat Pad Sign in Adult = Radial Head and/or Neck…

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5th MT Dislocation Xray

What’s the most effective way to examine a dislocation? For me, it’s significant to evaluate how the bones line up together. The most obvious finding is that the bases of the metacarpals do not line up. The Base of the 5 MC is proximal to the base of the 4 MC. This should be the first clue. The second clue is the marked soft tissue swelling of the hand on the lateral xray. Plus the lateral xray demonstrates the 5MC to be palmar to the…

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Avoid the Easy Button

At Premier, we strive to deliver nothing short of excellence; for us that means leveraging all areas of our expertise and resources in order to deliver the highest care, knowledge, and compassion for your patients. Is This a NORMAL Xray of the Hand? No? I Agree. But it was read as normal when a Radiologist “Hit the Easy Button” = “Macro Normal Right Hand” This patient complained of hand and wrist pain. The patient’s pain appears to be from their severe midcarpal row arthritis with…

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Kohler’s Disease X-ray

Appearances can be deceiving, and x-rays are by no means an exception. This image is a prime example of why it’s important to interpret the full picture of the image so that you can avoid a mis-diagnosis of any kind. Note the patchy fragmented markedly small and somewhat flat navicular. This reflects avascular necrosis of the Navicular in a skeletally immature patient: Kohler’s disease. This is a self-limiting entity and almost always resolves completely. It is important to alert the referring clinician to this diagnosis…

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Achilles Tendon Tear MRI and Abnormal X-ray

                                  The most valuable contribution we can make as radiologists is to catch abnormalities immediately and make informed diagnoses before irreparable damage can be done. Always ask yourself, “Have I evaluated this image closely enough? Have I examined this as closely as I would for a friend or loved one?” In the images presented above, the lateral x-ray of the ankle demonstrates attenuation in Kager’s fat pad with poor…

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