Os Trigonum




Can be mistaken for avulsion fracture of lateral tubercle of talus( Shepherd's fracture) or Fracture of steida process. Normally it is well corticated.

It may be the the source of Os trigonum syndrome or posterior ankle impingement syndrome in people performing repetitive plantar flexion activities. Posterior recess synovitis of the tibio-talar and posterior subtalar joint can occur due to impingement.  Flexor halluics tendon is located medial to the Os-trigonum and can get injured in the process.

Os trigonum is a secondary ossification center in the posterolateral aspect of the talus, which is present in approximately 5%-15% of “normal” feet. The ossification occurs between 7 and 13 years of age, and, within one year, the Stieda’s process is formed; however, it can remain as a separate ossicle in 7%- 14% of patients, usually bilaterally.

It is worth noting that the following individuals are more prone to develop Os Trigonum Syndrome: athletes of sports involving kicking; ballet dancers who assume the en-pointe and demi-pointe positions; and workers who use pedals, such as drivers and seamstresses.
 On physical examination, palpation of the posterior portion of the ankle joint, as well as
the passive maximum plantar flexion maneuver, causes pain.

Child with cough and fever since 15 days:



Right paratracheal and left hilar nodes favour mediastinal Tb.
Lungs are clear.

Lymph node Tb constitutes 20-40% of extra-pulmonary Tb. It is more common in children and women than other forms of extra-pulmonary Tb. It is more common in Asians and Pacific islanders. In developing and underdeveloped countries , it continues to be caused by M.Tuberculosis and atypical mycobacteria are seldomly isolated.

Commonly involved superficial lymph nodes are-

• Posterior and anterior cervical chain.
• Submandibular, peri-auricular, inguinal and axillary groups.
• Intra-throacic ( hilar-paratracheal and mediastinal in decreasing order of frequency)
• Abdominal nodes.

Frequency of associated pulmonary involvement is 5-62%.

Most patients can be managed medically and surgical intervention is rarely required

? Odontoid fracture

History of Trauma:

Cervical spine- Flexion and Extension View:



Atlanto Occipital assimilation and odontoid tip fracture. Confirmed on CT

BIRADS 5 lesion

A middle aged female with pain and lump in left breast-

Right breast:






Left Breast:





Upper -outer quadrant spiculated mass in left breast ( BIRADS 5)

Ref:

http://www.radiologyassistant.nl/en/p53b4082c92130/bi-rads-for-mammography-and-ultrasound-2013.html

Post Traumatic Osteolysis of lateral end of right clavicle




Bilateral erosions

• hyperparathyroidism

subchondral bony resorption; usually symmetric with osteopenia, abnormal trabecular pattern
the acromion is normal, but the sternoclavicular joint may be affected

• rheumatoid arthritis

bilateral or unilateral changes with soft tissue swelling, subchondral osteoporosis and erosion of the outer third of the clavicle
acromial erosions may occur later in the disease process

• scleroderma
• cleidocranial dysostosis
• pyknodysostosis (rare)

Unilateral erosion

• post-traumatic osteolysis
• myeloma
• metastases
• osteomyelitis

Cardiac Calcification's

1) Known case of Rheumatic Valvular heart disease and coronary artery disease-

Dense Mitral Annulus calcification

Approximate location-
Brown ring- Mitral valve
Yellow ring- aortic valve
Green ring-pulomnary valve
Purple ring- tricuspid valve
Dark red ring- aortic knuckle
Blue line- pericardial calcification

This case demonstrates calcification of the mitral valve annulus (not to be confused with mitral valve leaflet calcification which is the result of, and can cause, mitral valve disease).

Coarse calcification is seen in the expected location of the mitral valve, to the left of midline.  It is associated with conduction defects and coronary artery disease.

Other causes-

• Metastatic calcification in the form of myocardial calcinosis  is an entity need to be considered in patients with bone disease, hypercalcemia, hyperphosphatemia, renal disease or those on chronic dialysis. Complications arising from cardiac calcification include valvular dysfunction, complex atrial and ventricular arrhythmias, coronary events and sudden cardiac death.
• Calcified Peri-cardial cyst
• Calcified hydatid cyst of heart
• Intra-cardiac calcified aneurysm
• calcified old myocardial infarct
• Rheumatic valvular disease with calcification of the valvular leaflets
• Atrial appendage calcification ( also in RVHD and myocardial calcinosis)