March Case of the Month

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Access Case

Authors: Jay Karajgikar, MD, PGY-4, Radiology Resident, Diagnostic Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y., John O'Donnell, MD, Assistant Professor of Radiology, Department of Musculoskeletal Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y., Ralph Milillo, MD, Assistant Professor of Radiology, Department of Musculoskeletal Radiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, N.Y. 

Why did you select this case for submission?

I selected this case because when I initially came across it, I knew it was a rare entity that I would not encounter very often in my career. I knew that Charcot joint could affect the foot and ankle but not about how it could affect the major joints of the upper extremity, and I suspected there would be other residents and attendings who felt the same way. It is an entity in which knowledge of disease pathophysiology can greatly help in understanding its radiographic and MR appearance. This entity is applicable not just for the musculoskeletal radiologist but for the general radiologist as well.

What should readers learn from this case?

Readers should learn that although it is more common in the joints of the lower extremity, neuropathic osteoarthropathy (Charcot joint) can also occur in the upper extremity and spine. The 6D's is a very helpful mnemonic for learning the radiographic features of Charcot joint (dense bones, degeneration, destruction of articular cartilage, deformity, debris or loose bodies, and dislocation). The most common causes of neuropathic osteoarthropathy include diabetes, syphilis, and syringomyelia.

What did you learn from working on the case?

Primarily, I learned that while neuropathic osteoarthropathy most commonly affects the foot and ankle, it can also occur in the upper extremity. I also learned about the neurotraumatic and neurovascular theories that explain the underlying pathophysiology of Charcot joint.

How did guidance from senior staff at your institution impact your learning and case development?

My attendings initially showed me this case as an unknown interesting case, and we discussed the differential diagnosis in addition to the entity of Charcot joint. After deciding to submit to Case in Point, they were extremely supportive in going through the pertinent imaging findings and in creating educational questions.

Why did you choose Case in Point for submission of your case?

I personally have benefited greatly from many of the cases in the Case in Point archive, especially early on in my training. Case in Point is one of the primary forums through which residents and attendings can test their knowledge and stay on top of their skills through a vast array of interesting pathology and new cases published daily. I felt like this was the perfect forum for a case like mine, with a common entity in an uncommon location.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

The appeal of online learning, especially case-based programs like CIP, is its easy accessibility. In a world where we are all multitaskers, it is easy to take a few minutes and go through an interesting case. Nowadays, we all have smart phones and other mobile devices that allow us to quickly go through an online case and test ourselves and read up on an entity.

Are you a regular reader of Case in Point? What are your favorite types of cases?

I am a regular reader of CIP, not only to test myself, but also to build my fund of knowledge through the archived cases. GI/GU cases are my favorite because I will be going into body imaging.

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