Anterior Dislocation of the Shoulder ·         Glenohumeral dislocation most common shoulder dislocation (85%) ·         Glenohumeral joint dislocations make up >50% of all dislocations in the body ·         Anterior / subcoracoid shoulder dislocation (96%) ·         Mechanism o       External rotation and abduction and external rotation ·         Age o       Younger individuals ·         May be associated with o       Hill-Sachs defect (50%) is a depression fracture of posterolateral surface of humeral head from impaction of the head against glenoid rim in subglenoid type §         Best demonstrated on the AP projection with the arm internally rotated o       Bankart lesion is a fracture of anterior aspect of inferior glenoid rim §         Only cartilaginous portion of glenoid labrum may be fractured which may only be visible on MRI o       Fracture of greater tuberosity (15%) ·         Complications o       Recurrent dislocations (40%) o       Post-traumatic arthritis o       Injury to axillary nerve or artery Anterior Dislocation of the Humeral Head: Top image shows humeral head displaced from glenoid and lying inferior to the coracoid process (red arrow); the middle image demonstrates a defect along the posterolateral aspect of the head, which is the Hill-Sach's deformity (green arrow). The lower image is the scapular Y view (blue line outlines scapula). The head lies in a subcoracoid (i.e. anterior location). The white arrows point to the acromion.

Emphysematous Cholecystitis

General considerations Acute infection of gallbladder caused by gas-forming organism In about 1/3 = clostridium perfringens Also E. Coli and Klebsiella Rare – only 1% of all cases of acute cholecystitis Occurs more often in men As opposed to gallbladder disease in general which occurs more often in women Mostly are elderly patients (>60) with diabetes Vascular compromise of the cystic artery may play a role in the etiology Gallstones may be associated with the disease but are not thought to cause it Gas may occur in the wall and/or the lumen May spread to pericholecystic tissue Rarely, gas may escape into the bile ducts This is rare since cystic duct is usually occluded in cholecystitis Clinical findings As with cholecystitis, right upper quadrant (RUQ) pain and tenderness Leukocytosis Jaundice is rare Imaging findings Conventional radiography May show air in the wall or lumen of the gallbladder Air-fluid levels in the gallbladder will only be seen with images obtained with a horizontal beam, not on supine radiographs Gas may spread to the pericholecystic tissues These findings, if present on the conventional radiograph, usually herald a poor outcome from late-stage disease US findings   Indistinct shadowing emanating from wall or lumen of gallbladder “Ring-down effect” or “comet tail” from shadowing from air in gallbladder lumen CT findings of cholecystitis Air in gallbladder wall is diagnostic of this disease Most common signs of non-emphysematous cholecystitis are gallbladder wall thickening >3mm, and Cholelithiasis Increased density of bile (>20 H) Loss of clear definition of gallbladder wall Pericholecystic fluid such as a halo of edema Treatment Definitive care involves surgical intervention Preoperative percutaneous drainage may improve survival Emergency cholecystectomy Mortality of 15-25% Complications Fivefold increase in perforation over uncomplicated acute cholecystitis Perforation of the gallbladder Frequency is declining because of earlier diagnosis of acute cholecystitis Diagnosis Pre-perforation conventional radiograph showing stones clustered in gallbladder may subsequently show stones scattered in RUQ after perforation Pericholecystic fluid collection on CT or US (not-specific) Scintography may show radiotracer outside of gallbladder in Morrison’s pouch or flank Treatment Preoperative percutaneous drainage of gallbladder and biloma Emergency surgery

Emphysematous Cholecystitis. Supine view of the abdomen shows air in the wall (blue arrows) of the gallbladder (GB). There is also a lucency within the lumen of the gallbladder (GB) suggesting air inside the lumen. There is no air-fluid level visible because this radiograph is obtained supine with a vertical x-ray beam. Just superior to the gallbladder is another collection of air (red arrow) that represents a pericholecystic abscess. The yellow arrow points to the end of a PEG tube in the stomach.

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Garland's triad (also known as the 1-2-3 sign or Pawnbrokers sign) is a lymph node enlargement pattern which has been described in sarcoidosis.

It comprises of:

1. right paratracheal nodes
2. right hilar nodes
3. left hilar nodes

Involvement of right paratracheal nodes is not magical but rather reflects the ease with which these nodes are identified on plain radiography. Left paratracheal and aorto-pulmonary nodes are also frequently enlarged, but harder to identify ¹. 

The apple core sign, also known as a napkin ring sign, is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma. 

The coffee-bean sign or kidney bean sign or bent inner tube sign on an abdominal plain film :
sigmoid - cecum volvulus ( although some authors have also used the term to refer to closed loop small bowel obstructions )

Abdominal trauma, Shattered spleen, left renal segmental infarction and left hemothorax

CT bdomen with IV contrast revealed:-

- Hypodense zones are seen at upper pole of spleen.

-Hypodense area is seen at the left renal cortex.

-Hypodense lienorenal pouch.

-Laceated lower pole of spleen.

-Sparing the renal pelvic structures and  vascular bed.

-all that mentioned above consistant with left side abdominal hematoma with splenic laceration ,,and related to grade III.

The haemosiderin cap sign refers to an MR imaging feature in some spinal tumourswhere a cap of T2 hypointense haemosiderin is above and / or below the tumour due to previous haemorrhage. 

It is most often associated with spinal cord ependymomas, being seen in 20-33% of these cases ¹. The sign however may also be seen in hemangioblastomas and paragangliomasand therefore it is suggestive of but not pathognomonic for ependymoma.