MRI, CT, and US helped detect occult sites of thrombosis in a large majority of patients presenting with vaccine-induced thrombocytopaenia and thrombosis after receiving their first dose of the ChA... This case series reports 40 patients (median age, 41 years [interquartile range (IQR) 32- 52, 22 men) with confirmed vaccine-induced immune thrombotic thrombocytopaenia after administration of thei...

Aim of the study: Ankle pain can present a clinical dilemma to the foot and ankle surgeons, with a multitude of entities to which the symptoms could potentially be attributed. Enthesopathy around the ankle joint could be due to overuse, injury, inflammation or infection. Calcific ligamentous enthesopathy around the ankle is a well-recognised condition with a spectrum of causes. Case description: To our knowledge, a clinically symptomatic presentation of calcific enthesopathy specifically affecting the entheses of the superior extensor retinaculum has not been described in the literature. We report the first case of symptomatic calcific enthesopathy of the superior extensor retinaculum in a healthy young female, and highlight the role of radiological interventions in its diagnosis. The condition was managed successfully by ultrasound-guided barbotage. Conclusions: Calcific enthesopathy of the attachment of the superior extensor retinaculum is a rare condition that should be considered in the differential diagnosis of patients with medial ankle pain.

Background Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation. Aims We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles. Materials and Methods Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients (n = 100) into various groups based on the number of vertebral fractures. Results In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60–92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1–4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts (p-value = 0.0115). Conclusion Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures.

Introduction: The diagnosis of the rare congenital extrahepatic portosystemic shunts (CEPS) is of clinical significance because of the risk of hepatic encephalopathy, liver dysfunction and associated cardiac, gastrointestinal, vascular, skeletal and genitourinary anomalies. Symptomatology and investigations: This article describes two variant cases showing the same type of the extrahepatic congenital shunts (type II). Both patients were clinically asymptomatic. The first patient initially presented with unprovoked deep venous thrombosis (DVT) and staging-CT scan was performed to identify any potential underlying malignancy. The second patient was a poly-trauma where the CEPS was identified on the trauma CT. The first case underwent hepatological investigations including a fibroscan to rule out liver fibrosis and diagnosed as a type 1 congenital malformation, while the second case is under observation post recovery from his traumatic injuries, and will be subsequently referred to the hepatology team in the...

Bone lesions encountered as part of radiology practice can bring diagnostic challenges, both when encountered incidentally or suspected as a primary bone lesion, and in patients at risk of metastases or marrow-based malignancies. Differentiating benign from malignant bone marrow lesions is critical, yet can be challenging due to overlapping imaging characteristics. One key imaging feature that can assist with diagnosis is the presence of fat within the lesion. Fat can be present either macroscopically (i.e., visible on radiographs, computed tomography (CT), and conventional magnetic resonance imaging (MRI)), or microscopically, detected through specialised MRI techniques such as chemical shift imaging (CSI). This comprehensive review explores the diagnostic significance of both macroscopic and microscopic fat in bone lesions and discusses how its presence can point towards benignity. We illustrate the spectrum of fat-containing bone lesions, encompassing both typical and atypical presentations, and provide practical imaging strategies to increase diagnostic accuracy by utilising radiographs, CT, and MRI in characterising these lesions. Specifically, CSI is highlighted as a non-invasive method for evaluating intralesional fat content, to distinguish benign marrow entities from malignant marrow-replacing conditions based on quantifiable signal drop-off. Furthermore, we detail imaging pitfalls with a focus on conditions that can mimic malignancy (such as aggressive haemangiomas) and collision lesions. Through a detailed discussion and illustrative examples, we aim to guide radiologists and clinicians in recognising reassuring imaging features while also identifying scenarios where further investigation may be warranted.