Case of the Week: Hard left supraclavicular mass

Bilateral C7 cervical ribs. The left C7 cervical rib abnormally articulates with the left first thoracic rib, explaining the palpable mass of concern.

Liver volumes

Noda et al. Liver volume in children measured by computed tomography. Pediatric Radiology (1997) vol. 27 (3) pp. 250-2

Spleen volumes

Schlesinger et al. Volume of the spleen in children as measured on CT scans: normal standards as a function of body weight. AJR American journal of roentgenology (1993) vol. 160 (5) pp. 1107-9

Femoral/tibial torsion studies

Regarding Femoral/tibial torsion studies:

Dr. Stevens would like us to: 

1) Use the screen layout that I show in the second and third attachments 

2) Save our measurements when closing the study

3) Use the macro below

Also, please read the note on the first attachment regarding how he'd like us to measure the femoral neck.  

PS: The line about P. STEVENS in the macro is because Aoki does it differently.

_____________________________
Examination: [<Right>] MRI lower extremity without contrast limited. [] hours.

Comparison: Contralateral side.

History: Femoral anteversion. [<Lower extremity torsion.>]

Technique: Oblique PD axial images were obtained through the [left/right] hip. Native axial images were obtained through the hip, knee, and ankle.

Findings: 

No fracture, periosteal reaction, or other acute osseous abnormality is present in the visualized portions of the lower extremities. Soft tissues are normal appearing.

BY THE METHOD OF P. STEVENS AND B. NIXON,

lower extremity anteversion and torsion angles are calculated as listed below:

Impression: Femoral [<anteversion >] is [] degrees.  There is [] degrees femoral [<internal>] torsion and [] degrees tibial [<external>] torsion. Please see separate dictation of the contralateral limb.

_____________________________

Case of the week: 21 month old with stridor

Swallowed disk battery.

The ingestion of disk batteries is particularly important because saliva acts as an electrolyte bath, causing batteries to corrode and leak a solution of sodium or potassium hydroxide.  This caustic solution causes rapid destruction of the esophageal wall, extensive edema, and narrowing of the adjacent airway.

Head US and assessment of gestational age

Sagittal US views

Superior temporal sulcus (STS)                                           23 weeks

Saw tooth serrations STS (secondary sulcation)                     35 weeks

Cingulate sulcus (CS)                                                            29-30 weeks

Marginal branch of CS                                                           32 weeks

Long and short insular gyri                                                        39-40 weeks

          Left                                                                                40 weeks

          Right                                                                              39 weeks

Coronal US views

Superior frontal sulcus (SFS) – primary sulcation                    25 weeks

Secondary sulcation of SFS                                                 27 weeks

Adapted by Kevin Moore

Case of the week: 29 month old with elbow pain

Lateral condylar fracture.  The fracture line almost always extends into the unossified epiphyseal cartilage, and therefore these are Salter-Harris type 4 fractures, generally considered to be orthopedic urgencies.