MSK INTERESTING CASEBRIAN YUEN

30.8.2018

Case 1

• 57-year-old man

• Sudden onset on back pain 3 weeks ago when rising from sitting position.

• Then pain became much more severe over the ensuring 15 mins.

• Has settled more or less completely since then.

• Residual numbness L3 dermatome

L3

L2

L3

L2

• The appearances of the disc themselves have not changed in the least since an earlier MRI 18 months ago

• If this were an extrusion or sequestration from L2/3, the disc volume should reduce correspondingly.

5-week FU

Learning points

• Epidural hematoma vs sequestrated disc

• Epidural hematoma can be managed conservatively while sequestrated disc require surgical removal

CASE 2

• 75/M

• RTA victim knocked down by a taxi

• Trauma CT unremarkable

• Developed spinal shock and had an MRI

• Neurosurgeons performed laminectomy C2-4

• They did not identify any epidural hematoma intra-operatively

• The hematoma “disappeared” in the post-operative MRI a few days later

Learning points

• Epidural hematoma vs subdural hematoma

• Don’t forget to look at the soft tissue window

Case 3

• RTA

• Traction injury of right upper limb

Injury to musculocutaneous neve

Swollen musculocutaneous nerve x 5 normal size

affected Normal

Traction injury to MCN

Learning points

• Brachial plexus injuries can be broadly classified into pre-ganglionic and post-ganglionic injuries

• Ultrasound is a useful complementary tool to MRI

Case 4

• F/74

• Metastatic Ca bladder

• Right buttock pain + numbness

Case 5

• 6-month old infant

• Brought to A&E by parents for left leg swelling and redness

• History of axillary adenitis after BCG injection; otherwise good past health

Learning points

• Mycobacteria Bovis osteomyelitis is a rare complication after Bacillus Calmette-Guerin (BCG) immunization, occurring in less than 37 per 100,000 cases

• It can also occur following intravesical BCG for bladder cancer

Case 6

Aug Oct Dec

Case 7