Reasons not to try relocation of hips…

Dislocated hip

On this pelvis Xray you can see two hip replacements, the left one is dislocated.  If you look closely you can also see a fracture line just superior to the prosthesis near the greater trochanter.  Be careful reducing these without obtaining orthopedics input. 

The other prosthesis is interesting.  It is a hip replacement with a constrained acetabular liner.  You can see a radioopaque ring around the femoral head component of the arthroplasty.  This is a ring that functions to hold the hip in place.  If this dislocates (not in this case), then this requires open surgical intervention for relocation.  Don’t try to put one of these back in!

Image Contributor:  Hollis “Tag” Hopkins, MD

Author:  Russell Jones, MD

References

1.  THR: Constrained Acetabular Liners.  http://www.wheelessonline.com/ortho/12698


Filed under: Orthopedics, Pelvis XR, Trauma, XR Tagged: Hip

Multiple masses chest..

Late 20s male presents with shortness of breath…

Chest masses Chest masses CT

This Xray and CT show a phenomena called “Cannonball Metastases.”  This refers to innumerable descreet masses in the chest.  Two tumors are highly suspected in this case: renal cell carcinoma and choriocarcinoma.   Others that have a higher prediliction to multiple lung mets are prostate, endometrial, and synovial sarcoma (1). 

This patient ended up having a choriocarcinoma of the testes. 

Image Contributors:  Kevin Murphy, MD and Mary Bing, MD

Author:  Russell Jones, MD

References:

1.  Knipe H, Bickle I, et al.  Cannonball Metastases. www.radiopaedia.org


Filed under: Chest, Chest XR, CT, Non-Trauma, Respiratory, XR Tagged: Dyspnea

WWWTP #15 Answer…

Several days ago this CXR was posted:

WWWTP #15

This CXR has several interesting findings.  There is a heavily calcified mass in the left hilar region consistent with a calcified lymph node.  Also there are multiple discreet nodules in the lung parenchyma (best one is seen in the left upper lobe, also well seen in right middle and upper lobes). 

Turns out this patient had lived in the midwest region for most of his life.  This pattern can be seen with Histoplasmosis. 

Histoplasma capsulatum is a fungus that is highly prevalent in the Ohio and Mississippi valleys of the midwest.  Radiographically it commonly causes solitary pulmonary nodules, multiple tiny nodules (miliary Histoplasmosis), and lymphadenopathy.  Less commonly it can cause fulminant pneumonia.  The differential diagnosis, depending on the radiographic findings, can include Mycobacterium tuberculosis, Coccidioidomycosis, lung cancer, lymphoma, sarcoidosis, and others. 

Author:  Russell Jones, MD


Filed under: WWWTP

Bad orthopedics…

A patient presents with foot pain after a fall from a ladder:

Foot fracture 1 Foot fracture 2

This foot X-ray shows a hindfoot dislocation at the talo-navicular and calcaneo-cuboid joints with varus angulation.  This pattern is suggestive of a Chopart’s fracture/dislocation.

What is a Chopart’s fracture/dislocation?  Glad you asked!  It is a dislocation at the specified joints above (talo-navicular and calcaneo-cuboid).  This hindfoot joint is commonly referred to as the Chopart joint.  Please see radiopaedia.org for further discussion and an even clearer X-ray for educational purposes:

Chopart’s Fracture/dislocation

It is important to understand that this is a HIGH energy mechanism.  With these high energy mechanisms it is also important to consider other injuries including proximal tibia, hip, and lumbar spine injuries.  This patient also had:

Tibial plateau fx 2 Tibial plateu fx 1

This is a quite comminuted fracture of the tibial plateau that may even make an orthopedic surgeon cringe.

Author:  Russell Jones, MD


Filed under: Eponyms, Foot XR, Leg XR, Orthopedics, Trauma, XR Tagged: Chopart