February Case of the Month


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Authors: Kelly G. Ford, MD, PGY-3, Radiology Resident, The University of Tennessee Health Science Center, Memphis, Tenn., George A. Mayhall, MD, PGY-5, Radiology Resident, The University of Tennessee Health Science Center, Memphis, Tenn., and Benjamin W. Wilkerson, MD, Assistant Professor of Radiology, Department of Musculoskeletal Imaging, The University of Tennessee Health Science Center, Memphis, Tenn. 

Why did you select this case for submission?

While there were previous case submissions in the archive for bony manifestations of Langerhans cell histiocytosis (LCH), this case was in an older patient and demonstrated a different imaging finding. This case also had radiograph, CT, and MR correlates of the pertinent finding to allow for comparison of different modalities.

What should readers learn from this case?

To really understand a disease process, it’s important to be familiar with all the different ways it can present. Though diseases have “classic” findings (vertebra plana in a young child), seeing cases of unusual presentations (solitary lytic lesion in a young adult) helps remind readers to keep it in the differential when faced with a similar case in practice.

What did you learn from working on the case?

This case, like many of the CIP cases, is a great exercise in creating a differential. It was a great opportunity to remind myself the differential of a solitary lytic lesion in the spine and how it would change for various ages.

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

Some of the best teaching moments happen in the reading room when learning from an interesting case. This case was a great learning opportunity when it came through our system, and we felt other readers could benefit from working through the diagnosis in a case format. My staff and fellow resident were a great help in the design of the case.

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

Case in Point is a great resource that allows users to learn from an interesting case each day, and it also provides a searchable archive to highlight various presentations of the same disease process. The case structure is high yield, providing pertinent imaging and key teaching points in a quick timeframe.

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

Online learning provides flexibility and easier integration into a busy workday. The case archives are also more readily available to search for a specific diagnosis or compare different cases of the same diagnosis.

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

Yes, I’ve put it into my daily routine. I enjoy cases that have the ability to surprise you, whether it is an uncommon presentation of a common entity or uncommon diagnosis for what I thought was an obvious differential. I also like cases that use multiple imaging modalities for comparison.

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