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Background Suspected scaphoid fracture (SF) after a fall on an outstretched hand is a common presentation in the emergency department. Magnetic resonance imaging (MRI) or computed tomography (CT) has been suggested to assist in the diagnosis or exclusion of SF. Purpose To compare MRI and CT at diagnosing occult SFs. Material and Methods We routinely perform CT scans in patients with clinically suspected occult SF, after 7–10 days of injury following two negative radiographs. All eligible patients with a clinically suspected SF, but negative radiographs and a negative CT, underwent an MRI scan to assess further for evidence of occult fracture. Results A total of 100 patients were included in our study. MRI showed fractures in 16% of the time (in 15 patients) when plain radiographs and CT did not. Of these fractures, 8% were SFs. In addition to fractures, 10% had bone bruising. A total of 25% of patients with fractures and bone bruising were referred to the hand surgery team for further follow-up. Conclusion The study demonstrated that MRI would identify a radiographically occult SF more often than CT. This supports NICE guidelines which recommend MRI as the best early diagnostic tool for occult SFs.

We present a case of split and partially entwined sciatic nerve by a femoral prosthesis following closed reduction of a dislocated hip replacement. This complication is very rare and there are only few cases reported in the literature, with even less accompanied by supporting MRI. We present MRI features of a split and partially entwined sciatic nerve around a hip prosthesis.

An 85-year-old man was referred for an MRI scan of the pelvis for further evaluation of a suspected left neck of femur fracture, which was regarded as equivocal on plain radiograph and CT. The initial MRI demonstrated unusual appearances of the visualised bone marrow and subcutaneous adipose tissue and was initially misinterpreted as a technical malfunction of the scanner. However, a repeat study on a different scanner the following day once again demonstrated the same appearances. The appearances were consistent with serous atrophy of bone marrow, a non-neoplastic disorder of the bone marrow, which is most commonly seen in severe anorexia nervosa or cachexia. These unusual, but distinct, bone marrow and subcutaneous adipose tissue appearances, which are specific to MRI, have been colloquially termed as the ‘flip-flop’ effect.

A 24 year old man presented with a three year history of right groin pain, which was initially managed with physiotherapy for muscle strain. Pelvic radiography showed ill defined …

Although, the diagnosis and evaluation of sarcoidosis has traditionally remained confined to the chest, its multi-system nature has been widely recognized. Radiological features of pulmonary sarcoidosis are well known but extra-pulmonary manifestations can produce a plethora of non-specific imaging findings that can affect subcutaneous tissue, and the neurological, cardiac, gastrointestinal, urological, liver, spleen, and skeletal systems. In the literature, there are various case reports and specific system reviews but there are few reviews that encompass all the extra-pulmonary manifestations. In this paper, we comprehensively review the imaging features of extra-pulmonary sarcoidosis with characteristic features as well as atypical presentations. In addition, we discuss the emerging role of nuclear medicine in sarcoidosis.

AJR 2010; 195:S29–S31 0361–803X/10/1953–S29 © American Roentgen Ray Society Clinical History A 40-year-old man presented with a history of coccydynia of 8 months’ duration. The pain started after he fell on the coccyx while playing squash. He also complained of occasional tenesmus. No neurologic symptoms were noted. Clinical examination revealed only tenderness over the coccyx. Radiography, followed by CT of the thorax, abdomen, and pelvis, and MRI of the pelvis were performed. Ultrasound-guided biopsy of the mass was performed to confirm the diagnosis.

AJR 2009;193:S56–S58 0361–803X/09/1933–S56 © American Roentgen Ray Society Clinical History A 77-year-old man presented with neurogenic claudication of the lower limbs that had gradually progressed over the past 8 months. The pain was worse on the left side. Relevant medical history included lumbar spinal canal stenosis treated by left L4 laminectomy 5 years earlier. There was no associated sensory disturbance. MRI of the lumbar spine was performed.