May Case of the Month

May CIP

Access case here.

Authors: Michael R. Stetz, MD PGY-4, Radiology Resident, Resident, Department of RadiologyMedical College of Wisconsin Milwaukee, WI; Ross Cerniglia, MD Assistant Professor of Radiology, Musculoskeletal Imaging, Department of Radiology Medical College of Wisconsin Milwaukee, WI

Why did you select this case for submission?

This case was the first time I had come across this entity or diagnosis. After seeing the MR imaging findings, comparing them to the radiographic findings, and discussing them with staff, it seemed like a worthwhile investment of time to do some additional research. While the more senior staff in the department were familiar with the diagnosis, only a few had ever seen a case first-hand. So they suggested investigating it further and submitting it as an interesting and clinically relevant case. It seemed to me that if senior staff at a relatively busy academic institution had only ever seen one or two cases, it would be worth passing it along to the radiology community.

What should readers learn from this case?

Pediatric imaging can be a challenging endeavor when a case comes across the workstation. For those of us who are not pediatric fellowship-trained, the occasional radiograph of a pediatric patient can be a tricky situation if the finding is not immediately obvious. The goal of presenting this case was to hopefully add another tool to the thought process toolbox of approaching extremity injuries that don't fit nicely into common conditions –like buckle fracture, greenstick fracture, etc. Perhaps going forward, someone reading a case of pediatric trauma, which appears normal radiographically but clinically is still having symptoms,could at least suggest this diagnosis to the clinician and take appropriate action early to improve patient care.

What did you learn from working on the case?

This definitely reinforced that pediatric imaging can be difficult! Especially as a resident, this case is quite enlightening as to the nuances of pediatric radiography and how we use advanced imaging when the answer isn't clear on the most basic imaging tool we have available. For me, realizing how subtle a finding on radiography is and comparing that to the significant consequences of the actual pathology was quite eye-opening.

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

Senior staff encouraged me to do a bit of research on the topic after we read the MRI and realized what was going on. With this being my first experience with this entity – and seeing how subtle the radiographic findings can be compared to the MRI findings – and learning about the significant clinical impact a delay in diagnosis could have, they thought it would be a great case to submit.

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

I find Case in Point to be an efficient and effective way to review a broad range of different topics in radiology. The cases are quick to review, well-written, and the vast majority have at least a few points that can be immediately applied to daily practice. I find this type of CME to be the most beneficial. Hopefully this case fits well into that mold for those who read it.

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

I enjoy doing CIP regularly. It's a quick way to test my interpretation skills across all modalities and on topics I don't read on a daily. I invariably learn something about the subject of the case through either the questions or short case discussions. Having recently completed my MSK fellowship, I'm biased towards MSK cases. But I still enjoy testing myself on topics I don't see on a regular basis.

Is there anything else you’d like readers to know about your case?

The patient in this case went on to have appropriate care and is doing well!

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