Cervical spine injuries can involve the cervical vertebral column, intervertebral discs and cervical spine ligaments, and/or cervical spinal cord. The cervical spine accounts for ~50% of all spinal injuries.
5-10% of patients with blunt trauma have a cervical spine injury 1.
Testicular microlithiasis (TM) is a relatively common condition that represents the deposition of multiple tiny calcifications throughout both testes.
The most common criterion for diagnosis is that of five microcalcifications in one testicle, although definitions have varied in the past. In t...
Intracranial calcifications are common in certain locations and often are of no clinical concern.
The two most commonly encountered types of calcification include:
normal age-related intracranial calcifications
intracranial arterial atherosclerosis
Concerning calcifications are much less co...
Bone age assessment is an important part of the diagnostic and management pathway in children with growth and endocrine disorders. It is helpful in the diagnosis of various growth disorders and can provide a prediction of final height for patients presenting with short stature.
Bone age can als...
Artifacts can present in a variety of ways including abnormal shadow noted on a radiograph or degraded image quality and have been produced by artificial means from hardware failure, operator error and software (post-processing) artifacts.
There are common and distinct artifacts for film, comp...
Blumensaat line is the line drawn along the roof of the intercondylar notch of the femur as seen on lateral radiograph of the knee joint. It can been used for:
indicating the relative position of the patella as normally this line intersects the lower pole of the patella
suggesting ACL injury a...
Mosaic attenuation is the description given to the appearance at CT where there is a patchwork of regions of differing attenuation. It is a non-specific finding, which may be seen in any of the following:
obstructive small airways disease: low attenuation regions are abnormal and reflect decre...
Petrous temporal bone fractures are classically divided into longitudinal, transverse or mixed fracture patterns depending on the direction of fracture plane with respect to the long axis of the petrous temporal bone. Some features may aid in distinguishing them.
Codman triangle is a type of periosteal reaction seen with aggressive bone lesions. With aggressive lesions, the periosteum does not have time to ossify with shells of new bone (e.g. as seen in single layer and multilayered periosteal reaction), so only the edge of the raised periosteum will oss...
Pathological fractures are fractures that occur in abnormal bone. Although the term can be used in the setting of a generalized metabolic bone disease, it is usually reserved for fractures through a focal abnormality. The abnormality may be malignant or non-malignant in nature.
Posterior shoulder dislocations are far less common than anterior shoulder dislocations and can be difficult to identify if only AP projections are obtained. I high index of suspicion is helpful.
Posterior shoulder dislocations account for only 2-4% of all shoulder dislocations (t...
Fractures of the thumb are important due to huge impact the thumb has on the overall function of the hand, an understanding of the types of fractures that occur is important, as treatment varies with fracture type.
Metacarpal fractures include:
Dental (periapical) abscess is an acute infection of the periapical tissue around the root of the tooth.
Patients may present with pain, oedema, and purulent discharge localised to the site of pathology with or without fever and tender cervical lymphadenopathy 1.
Lymphoma is a malignancy arising from lymphocytes or lymphoblasts. Lymphoma can be restricted to the lymphatic system or can arise as extranodal disease. This, along with variable aggressiveness results in a diverse imaging appearance.
Lymphoma accounts for ~4% of all cancers 4. T...
Radiological manifestations of recreational drug use are not infrequently seen as the use of recreational drugs is widespread.
Interestingly, recent reports have suggested a decreasing incidence of reported drug use in the general population over the past decade, but it remains th...
Aseptic loosening is considered relatively common complication of hip joint replacements. It is usually considered a long-term complication and is often considered as the most common complication 3.
Aseptic loosening can occur as a result of inadequate initial fixation, mechanical lo...
Fracture-dislocations of the radius and ulna illustrate the importance of including the joint above and below the site of injury on radiographic assessment.
Most forearm fractures (60%) include fracture of the distal radius as well as an ulnar fracture. In some cases, there is associated disloc...
Barton fractures are fractures of the distal radius. It is also sometimes termed the dorsal type Barton fracture to distinguish it from the volar type or reverse Barton fracture.
Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. Therefore, i...
Flexion tear drop fractures are the most severe fracture of the cervical spine, often causing anterior cervical cord syndrome and quadriplegia.
It typically occurs from severe flexion and compression forces, most commonly at C5-6 (e.g. diving head first, motor vehicle coll...
Greenstick fractures are incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. They are commonly mid-diaphyseal, affecting the forearm and lower leg. They are distinct from torus fractures.
Greenstick fractures ...
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc may also be visible
These devices ...
Facial fractures are commonly caused by blunt or penetrating trauma sustained during motor vehicle accidents, assaults, and falls. The facial bones are thin and relatively fragile making them susceptible to injury.
Males are affected more commonly than females and facial fractures...
Epicondyle fractures are common injuries in children. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm.
Medial epicondyle fractures comprise most of these injuries. They can usually be treated with splinting and early physiother...
There are a vast range of lower extremity fractures. Below are listed several of such fractures of the lower limb. Many have eponymous names.
Pelvis and femur
anterior inferior iliac spine avulsion injury
proximal femoral fractures
Rib fractures are a common consequence of trauma and can cause life-threatening complications.
The 4th-10th ribs are the most commonly fractured 1. Fractures of the 1st-3rd ribs are associated with high-energy trauma 3.
When the rib is fractured twice, the term floating rib is used ...
Chance fractures, also referred as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. These are unstable injuries and have a high association with intra-abdominal injuries.
They tend to occur from a flexi...
Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
Post-traumatic neck pain after a high-velocity hyperextension injury is ...
Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.
The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and...
Extension tear drop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion, and unstable in extension as the anterior longitudinal ligament is disrupted. Extensio...
The small intestine is rarely the site of malignant tumours, although it accounts for ~75% of the entire length of the GI tract and more than 90% of the mucosal surface. Approximately 40 different histologic tumour types have been described.
In this article, an overview will be given of the mo...
Skeletal “don’t touch” lesions (also called leave me alone lesions) are so radiographically characteristic lesions that an additional diagnostic tests such as a biopsy are unnecessary and can be frankly misleading and lead to additional unnecessary surgery. Thus a radiologic diagnosis should be ...
There are numerous causes of urinary bladder diverticula:
Primary (congenital or idiopathic)
Hutch diverticulum (in paraureteral region)
Bladder outlet obstruction
bladder neck stenosis
posterior urethral valve
prostatic enlargement (hypertrophy; carcinoma)
Complete white-out of a hemithorax on the chest x-ray has a limited number of causes. The differential diagnosis can be shortened further with one simple observation: the position of the trachea. Is it central, pulled or pushed from the side of opacification? Is there pulmonary volume loss or vo...
Gastric diverticula are sac-like projections that usually originate from the gastric fundus, most commonly on the posterior surface. They are the least common gastrointestinal diverticulum.
Gastric diverticula are rare and commonly detected incidentally. The incidence varies from...
Pulmonary aspergillosis is a collective term used to refer to a number of conditions caused by infection with a fungus of the Aspergillus species (usually Aspergillus fumigatus).
There are a number of recognised pulmonary forms, the number depending on the author 1,3-4 . Each form has specific ...
Endometrial ablation is a minimally invasive surgical procedure that involves the destruction of the uterine endometrium commonly performed for menorrhagia in premenopausal or perimenopausal women.
It has evolved has an alternative to hysterectomy and is associated with good outcomes and patien...
Glass foreign bodies may be present if they are ingested, inserted or as a result of an injury.
The prevalence of glass foreign bodies in wounds from injury has been recorded at a rate of 1.5% in superficial (subcutaneous) wounds and 7.5% of deeper wounds 1.
Pneumatoceles are intrapulmonary air-filled cystic spaces that can have a variety of sizes and appearances. They may contain air-fluid levels and are usually the result of ventilator-induced lung injury in neonates or post-infectious. They should not be mistaken for a cavitating lung mass.
Blalock-Taussig shunt, also known as Blalock-Thomas-Taussig shunt, is a palliative procedure designed to increase pulmonary arterial blood flow in patients with right ventricular outflow tract obstruction (e.g. tetralogy of Fallot) or during initial staged repair of hypoplastic left heart syndro...
Atraumatic or spontaneous splenic rupture is rare, especially when compared to traumatic splenic rupture.
The pathogenesis of atraumatic splenic rupture is not well understood. Splenomegaly is present in almost all patients (~95%), although rupture of normal spleens (both in size an...
Triphalangeal thumb is considered a form of pre-axial polydactyly.
Triphalangeal thumbs have an incidence of 1 in 25,000 7.
A triphalangeal thumb, as the name implies, has three phalanges instead of the usual two. There is an autosomal dominant genetic transmission 8....
Coin lesion refers to a round or oval, well-circumscribed solitary pulmonary lesion. It is usually 1-5 cm in diameter and calcification may or may not be present 1,3. Typically, but not always, the patient is asymptomatic 1.
The differential diagnosis for such lesions i...
There are many complications that can occur following gastric banding. It is helpful to divide these into early and late post-surgical complications.
Although the exact mode of presentation can vary depending on the underlying complication common modes of presentation tha...
Medial epicondyle fractures represent almost all epicondyle fractures and occur when there is avulsion of the medial epicondyle. They are typically seen in children, and can be challenging to identify. Failure to diagnose these injuries can lead to significant long term disability.
Semimembranosus tendon avulsion is a specific type of avulsion injury that can occur in the knee.
Mechanism of injury
External rotation and abduction of the flexed knee or valgus force applied to the tibia. Associated injuries include anterior cruciate ligament (ACL) rupture and po...
Lumbar hernias are a rare form of posterior abdominal hernia.
Most common in patients aged between 50 and 70 years with a male predominance 1.
Patients with lumbar hernias can present with a variety of symptoms, including a posterolateral mass, back pain,...
March fractures are a name subtype of fatigue/stress fracture. They occur due to repeated concentrated trauma to a normal bone, classically the 2nd metatarsal of the foot but can occur in other weight-bearing bones of the lower limb and pelvis.
Please see the article on s...
An enlarged posterior fossa 'CSF' space posterior to the cerebellum has a number of differentials that include:
mega cisterna magna
Careful attention to the cerebellum needs to paid as also to be considered are:
The term ampullary tumour generally refers to either benign or malignant neoplasms that arise from the glandular epithelium of the ampulla of Vater, including 1:
ampullary adenoma (adenoma of ampulla of Vater)
ampullary carcinoma (carcinoma of ampulla of Vater)
According to some authors, ampu...
Gastric emphysema, referring to the presence of gas in the wall of the stomach is a relatively rare imaging finding 1. The stomach is the least common location for intramural gas in the gastrointestinal tract.
There is a wide range of causes, ranging from life-threateni...
Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. The lunate is displaced and rotated volarly. The rest of the carpal bones are in a normal anatomic position in relation to the radius.
These should not be confused with perilunate disl...
Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures.
Mechanisms of injury
requires high energy trauma (e.g. motor vehicle accidents account for 50% of scapular fractures)
direct trauma to the shoulder region
indirect trauma through falling on outstr...
Bowel wall thickening is a useful finding on imaging studies and has a number of different causes.
The reason for bowel wall thickening depends on the underlying etiology, but includes submucosal edema, hemorrhage, and neoplastic infiltration.
In describing bo...
Lateral epicondyle fractures are rare epicondylar fractures. They are much rarer than medial epicondyle fractures and represent avulsion of the lateral epicondyle. They are usually seen in the setting of other injuries 1-3.
Incidence typically peaks in the paediatric age group (6...
Renal papillary necrosis refers to ischemic necrosis of the renal papillae. Necrosis also occurs in the medullary pyramids.
Patients can present with both acute episodes or chronic renal papillary necrosis. Calyceal or ureteral obstruction by sloughed papillae manifest with f...
The Scham sign of slipped capital femoral epiphysis is one of the subtle signs that may be seen on the AP view of an adolescent hip with early slip.
In the normal adolescent hip, an intraarticular portion of the diaphysis of the collum overlies the posterior wall of the acetabulum inferiomedial...
The metaphyseal blanch sign (a.k.a. metaphyseal blanch sign of Steel) is one of the signs seen on AP views of the adolescent hip indicating posterior displacement of the capital epiphysis.
It is a crescent-shaped area of increased density, that overlies the metaphysis adjacent to the physis on ...
Testicular cancers are the most common neoplasm in men between the ages of 20 and 34.
Testicular cancer is uncommon, accounting for less than 1% of all internal organ malignancies 2.
The demographics of affected individuals depends on the age of the histology of the tumour. Over ...
Facial palsy refers to the neurological syndrome of facial paralysis. It can result from a broad range of physiological insults to the facial nerve or its central nervous system origins. The most common causes of this is Bell palsy.
While facial palsy refers to the clinical presen...
Pneumoconioses are a broad group of lung diseases that result from inhalation of dust particles. It is therefore considered part of the spectrum of inhalational lung disease.
The offending agents are mainly mineral dust. They can be broadly classified as 2-3:
Dextrocardia is a congenital cardiac malrotation in which the heart is situated on the right side of the body (dextroversion) with the apex pointing to the right.
Dextrocardia is believed to occur in approximately 1 in 12,000 people 2.
There are two main types of dextr...
Syringobulbia is a rare entity and refers to a syrinx that extends into the medulla oblongata 1.
Some authors use syringobulbia to refer to a syrinx present in any portion of the brainstem rather than specifically involving the medulla oblongata, and therefore encompassing syringop...
Syrinx is the collective name given to hydromyelia, syringomyelia, syringobulbia, syringopontia, syringomesencephaly, and syringocephalus.
The use of the general term 'syrinx' has grown out of the difficulty in distinguishing between hydromyelia and syringomyelia using current imag...
The rule of 4 of the brainstem was devised by Peter Gates, an Australian neurologist, in 2003 in order to simply explain the anatomy of the brainstem and basis of brainstem stroke syndromes to the non-neurologist and medical student 1-3. This article summarises Gates' four rules, associated impo...
Nightstick fractures are isolated fractures of the ulna, typically transverse and located in the mid-diaphysis and usually resulting from a direct blow. It is a characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant (or local law enforcement offic...
Scheuermann disease (also known as juvenile kyphosis, juvenile discogenic disease 11, or vertebral epiphysitis) is a common condition which results in kyphosis of the thoracic or thoracolumbar spine. The diagnosis is usually made on plain film.
occurs in ~5% (range 0.4-8%) of the ...
Multiple endocrine neoplasia (MEN) syndromes are a collection of syndromes characterised by the presence of, as the name would suggest, multiple endocrine tumours. They are autosomal dominant in inheritance.
MEN1 (Wermer syndrome)
MEN2 (multiple endocrine adenomatosis)
MEN2a (Sipple syndrome)...
Spinal fractures are usually the result of significant trauma to a normally formed skeleton, or the result of trauma to a weakened spinal column. Examples include:
Jefferson fracture: ring fracture of C1
hangman fracture: bilateral pedicle or pars fracture of C2
There are numerous fat containing renal lesions, including:
renal cell carcinoma
renal or perirenal lipoma
Non-mass lesions may also occasionally contain fat:
renal junction line
fat in a renal scar
renal sinus lipomatosis
Bladder outlet obstruction (BOO) can arise from a number of conditions affecting the urethra and/or bladder outlet.
Patients often present with difficulty in urination, retention and urinary discomfort 2.
Obstruction can be caused by multiple etiologies...
Pulmonary arterial calcification is the phenomenon which is usually seen in the setting of advanced pulmonary hypertension. It can however be uncommonly present in those without pulmonary hypertension.
The general mechanism in the vast majority is thought to be from high end pulmonar...
Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus associated with hyperinflation of the distal lung.
On imaging, it commonly presents as a proximal focal tubular shaped opacity radiating from the hilum associated with a dista...
The musculoskeletal manifestations of cystic fibrosis are uncommon compared to the well known respiratory manifestations.
Symptoms are non-specific and include joint pain, joint swelling, back pain, and myalgia. These may mimic rheumatic symptoms, however, they do not me...
Ranawat's line is the perpendicular distance between the centre of the sclerotic ring of C2 and a line drawn along the axis of the C1 vertebra.
Normal value is 17 mm in males and 15 mm in females. It is decreased in basilar invagination.
History and etymology
Chitranjan S Ranawat is an Americ...
Several cystic and cyst-like orbital lesions may be encountered in imaging of the orbits:
developmental orbital cysts
dermoid: commonest benign orbital tumour in childhood
congenital cystic eye
Bone within a bone is a descriptive term applied to bones that appear to have another bone within them. There are numerous causes including:
thoracic and lumbar vertebrae (neonates and infants)
growth recovery lines (after infancy)
cortical splitting and new periostitis
sickle cell d...
Intraconal orbital lesions are broadly divided into two main groups; those with or without involvement of the optic nerves:
Lesions with optic nerve involvement:
optic nerve glioma
optic nerve meningioma
lymphoma and leukaemia
Laryngeal cysts can occur in any part of larynx, but are more frequent in supraglottic locations, such as the epiglottis and vallecula. The prevalence of each location varies on different studies.
The laryngeal cysts represent a rare group, about 5%, of benign laryngeal lesions 1...
Ingested bones that become lodged in the throat or gastrointestinal tract are a common presentation to the emergency department. Recognition is important because these cases can be potentially fatal.
Patients may present with a 'foreign body' feeling in the throat after eating fish ...
Heterogeneous echogenicity of the thyroid gland is a non-specific finding and is associated with conditions diffusely affecting the thyroid gland. These include:
Scrotal tunica cysts are paratesticular cystic lesions. They include:
tunica vaginalis cysts
tunica albuginea cysts
Typically seen as a simple appearing paratesticular cystic lesion not in the region of the epididymis.
Extraconal orbital lesions include lesions which arise from structures within the extraconal orbital space and those extending from adjacent structures into the orbits.
dermoid cyst: most common lesion in paediatrics
lacrimial gland lesions
Renal artery stenosis (RAS) refers to a narrowing of a renal artery. When the process occurs slowly, it leads to secondary hypertension. Acute renal artery stenosis does not lead to hypersecretion of renin.
When the stenosis occurs slowly, collateral vessels form and supply the kidne...
Renal amyloidosis is rare as an isolated entity but can be associated with systemic amyloidosis. Renal involvement from amyloidosis in pathological specimens is quite common. However, renal function compromise is rare.
It usually manifests as nephrotic syndrome:
Patients with malignant ureteric obstruction and poor life expectancy usually require placement of ureteral stents to relieve the urinary obstruction and as a palliative measure to reduce pain and avoid major operation.
Metallic ureteric stents have recently been developed to try and offer bett...
There are relatively few of causes of low signal intensity renal parenchyma. Causes include:
paroxysmal nocturnal haemoglobinurea.
mechanical: malfunctioning prosthetic cardiac valve
sickle cell disease
hemorrhagic fever with renal syndrome (HFRS)
Haematospermia refers to the presence of blood in semen or ejaculatory fluid. It is a symptom that can cause great anxiety to patients despite commonly being of benign aetiology.
urogenital infections including sexually transmitted disease
commonest cause in <40 years of ...
There numerous causes of gas in the bladder. In the hospital setting by far the most common is the recent placement of an indwelling urinary catheter. Other causes include:
IDC by far the most common cause
intraluminal and intramural gas
The term epidermoid cyst can refer to a:
epidermal inclusion cyst
intracranial epidermoid cyst
splenic epidermoid cyst
spinal epidermoid cyst
testicular epidermoid cyst
Congenital anomalies of the male urethra include various anomalies due to complex development of urethra. These anomalies can be isolated or in association with other coexisting anomalies. They can be categorised as following:
posterior urethral valve
anterior urethral valv...
Bilateral testicular lesions have a relatively limited differential diagnosis.
lymphoblastic leukemia (acute or chronic)
primary testicular lymphoma is rare but the testes are often the site of lymphoma/leukemia recurrence due to ...
The leukodystrophies are dysmyelinating disorders which typically, although not invariably, affect children. They include:
lysosomal storage diseases
globoid cell leukodystrophy (Krabbe disease)
Birth trauma relates to those conditions caused by both physical/mechanical and hypoxic injuries.
Birth trauma occurs in ~5 per 1000 births 2.