Torsion of the fatty appendage of the falciform ligament, part of the spectrum of conditions known as intra-abdominal focal fat infarction (IFFI), is very rare with less than 20 cases reported on imaging so far. Here we report a case of torsion of the lipomatous appendage of the falciform ligament in a middle-aged female, diagnosed on ultrasound and computed tomography (CT). CT showed classical “hyperattenuating rim” sign in the anterior perihepatic space adjacent to the falciform ligament. We re-emphasize the importance of “hyperattenuating rim” sign on CT in recognizing IFFI in locations other than the pericolic region.

Introduction: We studied the prevalence of celiac trunk and its anatomical variations on diagnostic computed tomography angiography (CTA) studies and have proposed a new classification to define the celiac artery (CA) variations based on embryology.Material and methods: We retrospectively assessed the celiac trunk variations in 1113 patients who came to our department for diagnostic CTA for liver and renal donor workup. The patient data were acquired from the Picture Archiving and Communication System of our institutions. We analysed the celiac trunk’s origin and branching pattern, including the superior mesenteric artery (SMA) and inferior phrenic artery (IPA).Results: We evaluated the CTA studies of 1050 patients. A normal trifurcation pattern, the most common type, was observed in 39% of cases. Variation with CA + left IPA was the most common subtype. Other variations noted in the study and their incidences are listed in the table below. We attempted to propose a new classification based on embryo­logy, which comprises 6 main types and their subtypes. We also analysed previous studies from the literature, including cadaveric, post-mortem, CTA, and digital subtraction angiography studies and compared them with the present study.Conclusions: Because variations of CA classifications reported to date do not encompass all CA branching pattern variants, we have proposed a new classification that incorporates most of the variants. We reiterate the clinical importance of anatomical variants of CA, IPA, and SMA in surgical and interventional radiology procedures.

A 13-year-old boy presented to the orthopedic clinic with a 1-week history of pain in both knees. He was active in sports and had participated in the long jump during the previous 6 months. He reported no specific trauma, fever, or other joint symptoms. A physical examination of the right knee showed mild soft-tissue swelling and tenderness over the tibial tubercle, and the right quadriceps muscle was taut. The left knee was normal. Plain radiographs of both knees, which were obtained to rule out an avulsion fracture given the patient’s history of participation in the long jump, showed sclerosis and fragmentation of the tibial tubercle in both knees, with soft-tissue swelling on the right knee (arrow). These characteristic findings led to a diagnosis of Osgood–Schlatter disease, or osteochondrosis of the tibial tubercle, caused by repetitive traction of the patellar tendon at its attachment on the tibial tubercle. Osgood–Schlatter disease typically occurs during the early adolescent growth spurt between 10 and 15 years of age, particularly in children who participate in sports that involve running and jumping. Most cases resolve with supportive treatment. The patient received treatment with ice and nonsteroidal antiinflammatory drugs and was provided with instructions for stretching and strengthening exercises for the quadriceps and hamstring muscles. At a follow-up visit 3 weeks later, the patient reported less pain but stated that he chose not to resume participation in the long jump.

Study DesignRetrospective study.PurposeIdentification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae.Overview of LiteratureMany studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results.MethodsWe studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department.ResultsIn our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12–L1 in most patients in the normal and sacralization groups.ConclusionsCF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.

Study DesignA retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population.PurposeThere have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population.Overview of LiteratureCoccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations.MethodsA retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type.ResultsTypes I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females.ConclusionsType I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.