Inflammatory Bowel disease: Crohn's

A 40 yrs female with history of loose non bloody watery stools, weight loss and odynophagia since few months-

The Barium Meal Follow Through Spot compression images reveal eccentric narrowing of the distal small bowel loop with anti-mesenteric pseudosacculations.  The distal ileum stands distinct due to mesenteric fibro-fatty proliferation displacing it from rest of the small bowel. Cecum also shows cobble stone appearance. 

Large bowel colonsocopy upto hepatic flxure reveals serpiginious ulcers with spared normal mucosa giving cobble stone appearance relatively sparing rectum.

Small bowel strictures at two distinct sites involving ileum as detected on Small Bowel Enteroclysis:





There is prestenotic dialation. The strictures are short segment.

Traumatic rupture of Bulbar Urethra. Pelvic bone fractures with peri-prostatic hematoma displacing the bladder upwards:

Twisting injury to Foot : Avulsion injury to base of 5th Metatarsal






The fractures at the base of the 5th metatarsal are transversely oriented to the shaft of metatarsal.
Unfused apophysis is laterally located and is longitudinally oriented ( It is seen on radiograph  at 10 to 12 yrs in girls and boys respectively and fuses within next 2-4yrs).

Another case:

Here the line at the base of 5th metatarsal is transversely oriented and only involves the tip so it is a avulsion fracture.

This is most common avulsion injury of foot and most common type of injury ( 90%) at the base of the 5th metatarsal.  It is caused due to forceful plantar inversion in flexed foot of postion with avulsion of the insertion of peroneus brevis. It may or may not extend into the metatarso-cuboid joint.

Accesory ossicle just at the base of 5th metatarsal is called Os Vesalianum( very rare) while lateral to the cuboid is called Os Peroneum are other differentials but they are well corticated seasmoids.

Islein Disease: is apophysitis of the base of 5th metatarsal due to repetitive traction by peroneus brevius usually in young persons engaged in the sports activities. There is irregularity of the apophysis or bony specks in this region.

Thus Most common fracture at the base of 5th metetarsal is Avulsion injury , f/b Jones f/b Stress fracture.

A young male came with complains of acute retention of urine and supra-pubic pain. He gives recent history of a obstructive right ureteric calculus.

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RADIOGRAPH ABDOMEN (KUB) – SUPINE A. P. VIEW

Poor bowel preparation.

Small 6mm and 4mm radiopacities in the region of symphysis pubis probably urethral calculus. Kindly correlate with USG KUB.

No other abnormal calculus density is noted in the region of urinary tract.

Impacted Urethral Stone.

In a KUB Radiograph include the symphisis pubis region so as not to miss out this.

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