SET T0046 -
Mixed ED Cases -
2019

OBSERVATIONS:

a). A fat fluid level (FFL) is present (indicating the high probability of an intra-articular fracture).

b). Three classic features of a fracture of the lateral tibial plateau are present: disrupted plateau; lateral displacement of the plateau; increased density of the lateral aspect of the subplateau area of the tibia (ie because bone has been driven into bone).

c). Incidentally, these radiographs suggest that a fracture through the head/neck of the fibula is also present.

SUMMARY:

The important finding is the fracture of the lateral plateau of the Tibia.

The bones and joints appear normal.

There are multiple abnormal appearances. They can be listed as follows:

(a). C1 / C2 subluxation - as shown by the gap between the odontoid peg and the anterior arch of C1 vertebra. In the context of the recent trauma this is likely to be explained by a rupture of the transverse ligament. The odontoid peg appears intact.        (b). The body of C3 vertebra is compressed (slightly). This could be longstanding (ie an old osteoporotic compression fracture) or it might be a more recent fracture.       (c). Slight compression of the body of C7 vertebra. See explanation / possibilities in (b) above.           (d). Slight forward subluxation of C7 on T1 vertebra. Again, difficult to distinguish between an old (ie ligamentous) injury and a more acute injury. If there are elsewhere previous radiographs of the cervical spine - that would be most helpful.          (e). Degenerative disc disease at several levels.

SUMMARY: The important injury is the C1 / C2 subluxation. Other abnormalities listed. NOTE: The (subsequent) CT confirms the findings and impressions described in relation to the plain lateral radiograph.

Observations:

The lungs are clear. No evidence of a pneumothorax.

The cardiac shadow is unremarkable.

Both hilar shadows are abnormal. Specifically, they are enlarged. [Normally, the hilar shadows have outlines that are solely due to the normal vessels. In this patient, both hila show "lumpy" enlargement.] This represents bilateral hilar lymphadenopathy.

The right paratracheal shadows are unremarkable.

Conclusion:

Bilateral hilar lymphadenopathy. There is a differential diagnosis for this appearance - but the most likely diagnosis is sarcoidosis.

[Follow up confirmed the diagnosis of sarcoid].