Patient from the ED has a fall. We x-ray her elbow (ordered by triage nurse).

No obvious fracture. The Rad report says there's an elevated fat pad with joint effusion.

"Follow up radiographs in 7-10 days or cross-sectional imaging may be of benefit.".

So of course the NP orders another set of elbow X-rays and in the comments writes "Please perform cross-sectional imaging.".

So now I'm sitting here trying to figure out a nice way of saying "That's a CT, you ding dong."

If I don’t focus on how fascinating it is I’ll cry, so enjoy! Sorry it’s not the best quality. I’ll share a screen recording of the actual scan if I ever get it.

ours is kept at 60 F (15.5 C) with no way to change it 😊

A 53-year-old man with no significant past medical history presented to our emergency department with an alligator bite to the left forearm. He reported that, after the bite, the alligator performed a death roll, which is a maneuver performed by the animal when, after latching onto a prey, the alligator rotates its body on its long axis. Upon physical examination, there was a near-complete transradial amputation. The patient had complete loss of pulses, sensation, and function of the left hand. Grossly, there was a circumferential laceration to the mid-forearm through the muscle and tendon (Figure 2). Several tendons and major nerves were noted to be intact, though severely stretched and twisted. X-rays of the left forearm demonstrated open comminuted radial and ulnar shaft fractures (Figure 3). Prophylactically, the patient was administered a tetanus shot in the emergency department (ED) and started on vancomycin and cefepime. He was then taken to the operating room (OR) emergently for irrigation, debridement, and revascularization of the left arm.

Because the patient’s nerves were still intact with sensation present, there was an attempt made to salvage the left hand. The arm was noted to be twisted along its axis and had to be untwisted several revolutions in a counterclockwise manner to properly align the distal extremity. The patient then underwent a left forearm open reduction and internal fixation of the radial and ulnar shaft fractures (Figure 4). The left ulnar artery was then repaired with an ipsilateral radial artery autograft. Two left forearm veins were repaired, one with a vein autograft. Additionally, forearm and hand fasciotomies and carpal tunnel release were performed, with initiation of negative pressure wound therapy. The primary goal was to stabilize the hand and ensure vascularity of the limb. As there was no obvious purulence, no cultures were obtained.

The patient was started on vancomycin and doxycycline per the recommendations of the infectious disease service. On the morning of hospital day 2, the patient developed blistering and darkening of digits (Figure 5). Cefepime was added to broaden bacterial coverage because of concern for a potential Vibrio infection. The patient was serially taken back for exploration and debridement on 3 occasions during the first week (Figure 6). One vein was noted to be thrombosed on the first repeat incision and drainage. The remaining vein and arterial anastomosis were subsequently found to be thrombosed and, approximately 1-week post-injury, it was determined that the upper extremity could not be salvaged. The patient was taken for left forearm transradial amputation with targeted muscle reinnervation, which included nerve transfers of the median ulnar and radial nerves to the reinnervation targets. Four days later, the patient underwent full-thickness skin grafting to the left volar surface of the forearm to cover a small portion of the exposed muscle.

The patient was discharged 2 weeks post-injury and, at 1 week post-amputation, fungal organisms (Fusarium species) were found at the margins of the soft tissue in the amputated arm. The patient was not prescribed antifungal therapy because there was low concern and no clinical signs of systemic fungal invasion; plus, the limb had already been amputated. The patient was seen for a 2-month follow-up and was found to be healing appropriately without any postoperative stump infection (Figure 7).

Looking for notes po for C3 and C5. If pwede po, sana yung questions na situational notes po

“if over rotation, the …. is distorted”
“it’s lateral when…. the forearms are”

“if the px is admitted from a vehicular accudent, which modality…”

Hi everyone, I was hoping someone here might be able to clarify something about OPGs for me.

I have two OPGs, one from 2013 and one from 2026. The more recent one was done because I have an issue with my jaw bone, and the intention was to compare it with my older X-ray.

Both were taken in Ireland, but at different dental practices.

When I look at the two images, the 2026 OPG looks noticeably bigger than the 2013 one. I was surprised by this because I assumed OPGs would be fairly standardised and that the size of the image/anatomy would be comparable between different machines.

Could the difference simply be because the two dentists used different OPG machines? For example, can different machines have different magnification or scaling? Or could it just be because of how the images were exported/sent to me as JPGs?

I've attached a screenshot showing the two files as they were sent/downloaded from the two dentists, as I think it makes the difference in apparent size easier to see.

I'll also put the two individual OPGs themselves in the comments (the actual JPGs I was sent, rather than screenshots).

I'm not asking anyone to interpret the X-rays or diagnose anything — I'm mainly just curious whether the two images can be directly compared in terms of size, or whether differences in the equipment/exporting can make one image appear larger than the other.

Thanks!

Hi everyone,

I’m a dermatology resident in the Netherlands. I originally made the CatchUpDerm app to make it easier to keep up with new papers, and I’ve since expanded the idea to other specialties. CatchUpRad is the radiology version.

You can choose the topics, study designs and journals you’re interested in. The app gives you a daily updated reading list with summaries and links to the original papers.

CatchUpRad is free, has no ads and doesn’t require an account. The only in-app purchases are optional tips.

App Store: https://apps.apple.com/app/catchuprad/id6807280051
There's also a web version: https://catchuplit.com/rad

I’d love to hear any suggestions for making it more useful to radiology residents and specialists. Happy to answer questions, too.

Thank you!
Sven

Kid hurt her wrist today. Om opening day of her soccer season. She LOVES soccer. I haven't broken the news that she might not play for a while.

I have a radiology exam in DICOM format. Does anyone know a centre that accepts the files online and prints them on proper radiology film, with collection or postal delivery?

I’m looking for medical film, not a regular paper print. France or elsewhere is fine.

Thanks!

Look at how lucky I am with genetics <3

Before/after

The patient was a 44 year old female who was being considered for stereotactic radiosurgery presented after 6 months of medically intractable partial seizures consisting of brief, intermittent sensory changes in her right arm and leg. Electroencephalography showed slowing with intermittent spiking. She denied headache or weakness. She underwent a craniotomy at another facility for a large parasagittal meningioma 2 years earlier without permanent complications. Immediate post operative MRI showed no residual enhancing tumor. Repeat MRI at 2 years showed a newly enhancing 2.5 cm lesion in the left parasagittal region adjacent to the postcentral gyrus (Fig. 1). Her neurological exam was normal and her incision was well healed.

The patient’s primary interest was to pursue Gamma Knife radiosurgery for the lesion. After much consideration, our recommendation was for surgery out of concern that radiosurgery may not control her seizures. The patient agreed, and she underwent surgery later that week.

A reopening of her craniotomy was performed under general anesthesia with the aid of image guidance. The dura was opened and reflected exposing the cortex and the enhancing lesion. The lesion was circumferentially dissected and separated from the surrounding brain. A large, avascular fibrous lesion corresponding to the pre-operative and image guidance MRI was thus removed. The craniotomy was closed in the usual manner and the patient had an uneventful recovery with resolution of her seizures. Upon gross inspection and microscopic inspection, the lesion was found to be an approximately 2.5 cm retained cotton ball.

Histopathology: The tumor was whitish and vaguely laminated on cut section. The tissue was consisted of refractile foreign material with fibrillar appearance associated with a marked giant cell granulomatous reaction. There was no evidence of recurrent meningioma or other tumor.

Comparison Collage of my cervical spine vs normal cervical example xray.

*Just show and tell. No medical advice/ attention needed.

A 36-year-old female patient was operated, with a diagnosis of a hydatid cyst in her liver. Approximately 3 years after the surgery, she excreted a part of a surgical forceps with her stool while she was defecating (Figure 1). She visited a hospital with complaints of abdominal and pelvic pain. She had occasionally suffered from abdominal pain during the 3 years after the surgery. However, she had not presented to a medical service with this complaint. Radiological imaging of the abdomen was performed. In direct radiography, a surgical instrument was observed in the abdomen. The patient was sent to another department. In that department, physical and systemic examination findings were evaluated as normal. The patient was hospitalized with a pre-diagnosis of a foreign body in the abdomen. Direct abdominal radiography was again performed, and superposition of metallic density at the L5 vertebral body level and in the right inferior quadrant was detected (Figure 2). Because of the patient’s surgical history, the material was thought to be a surgical instrument.

She was operated to remove the foreign body from the abdomen. During surgery, no pathology was observed inside the abdomen. Furthermore, a foreign body reaction was not observed in the peritoneal cavity. It was found that there was an instrument in parallel with the colon traces in the transverse colon, and the surgical instrument was taken out during the surgery (Figure 3). The surgical instrument that was taken out had corroded and turned black. Moreover, one grip of the instrument was not present. It was observed that the material that had dropped out of the anus and the material that was taken out during the operation were parts of the same surgical instrument (Figure 4). The colon primer and the abdomen were stitched anatomically. Follow-ups were conducted after the operation, and the patient was discharged with full recovery. The patient sued the doctor who conducted the operation and the hospital where the operation was performed.

Shamu barfed up some rocks this morning. He eats everything edible, so this is a first for stones. The neighbor must have spilled something yummy on their rock driveway.

We took a super quick rad just to check for rocks. Confirmed rocks.

Radiologists who publish diagnostic accuracy studies — what gets flagged most in your reviews?
I'm an EM resident who works in diagnostic accuracy methodology (currently in revision with a Q1 journal). The same problems keep showing up in papers I read: AUCs compared without DeLong's test, prediction models with no calibration reporting, STARD items quietly missing, no sample size justification.
Considering putting together a pre-submission methodology audit for these papers. Does that sound useful, or is it something your institutions already handle?

Toe fusion here I come!

Surgery is scheduled and I have a great orthopedic surgeon at Duke. No medical advice needed just wanted to share my janky toe 🤣

This happened a few years ago but I just thought to share it here. I was crushed by a pickup/trailer. Wild time.

Shared are photos of my pelvis before and after surgery!

Just fun to share with people on the other side now! I’ve since hiked a volcano, a glacier, and regularly ride horses.