OM with fractures

Elderly patient. History of trauma -his foot was hit by household gas cylinder when he was trying to lift it 8 days back. Pain, swelling and redness over the foot since 8 days-

Fracture involving the proximal shaft of proximal phalanges of 3rd to 5th toe.
Marrow lytic areas along all the phalanges with soft tissue swelling s/o osteomyelitis.

Left atrial enlargement 

Enlarged left atrium moves to right and back causing  double density along right heart border, lateral displacement of the pulmonary veins making them prominent, splaying of carina and indenting the anterior wall of lower 1/3rd of thoracic esophagus.

Causes-

• Mitral stenosis
• Left ventricular failure
• congenital heart disease-PDA,VSD

Limbus Vertebra (L4) not to be mistaken as fracture in lumbar spine

Calcified splenic granulomas in a patient treated for abdominal Tb

Terminal ileal obstruction and  perforation.

A 45 yrs male vomitting and abdominal distension-

Air fluid levels ++
Many areas of pneumoperitoneum.


Ct scan revealed terminal ileal stricture

Chemical Pneumonitis

A young male in an suicidal attempt drank 4 litres of kerosene.

Kerosene Pneumonitis in bilateral lower zones. He was on positive pressure ventilation and developed pneumothorax as the lung is very friable due to kerosene induced damage.

Elbow joint- Watch out for the fat pads!!

1 )35 yrs male with history of trauma

Sail sign- Anterior displacement of anterior coronoid fossa fat pad due to joint effusion.
Posterior fat pad is displaced out from the olecranon fossa.

These features favour joint effusion. In adults the commonest site of intra-articular fracture producing these signs is the radial head. The subtle radial head fracture is also seen in above images.

In children its the supra-condylar fracture which produces these signs.


2) Radius neck fracture with fat pad sign-