Little Leaguer's Shoulder

Above are MRI images of a 13 year old male baseball pitcher. They are a coronal proton-density (left) and a T2-weighted images displaying a widening of the lateral humeral growth plate.

Little Leaguer's Shoulder is a sports injury occurring from overuse of the joint. The average age for this condition is 14 years old. The most common symptom is pain in the proximal humerus during pitching.

Treatment of this condition includes refraining from pitching for at least three months followed by gradual return to pitching once the shoulder is asymptomatic.

If a patient does not allow the shoulder to heal and the growth plate remains damaged, the result can be a delay in growth in that area.

Acetabulum Fractures

The above image is a surface-rendering 3D CT scan view laterally with the right hemipelvis and left femur removed demonstrating a transverse fracture as well as a displaced and comminuted posterior wall fracture fragment.

Fractures of the acetabulum often occur in automobile or motorcycle accidents, falls, or industrial accidents, when a strong force pushes the head of the femur through the acetabulum.

When these fractures occur they disrupt the smooth surface of the hip joint as well as the fit of the femoral head into the acetabulum and usually require surgery to repair.

The surgical procedure will often include screws and or plates fixated to the damaged areas to hold the fragments in position for healing. Surgical complications can include wound infection and nerve damage, however they are rare. Post operative patients will remain in the hospital to be monitored for pain, infection, and deep vein thrombosis which could lead to a pulmonary embolism.

Fatty Infiltration of the Liver

Fatty infiltration of the liver, also known as fatty liver, is an accumulation of fat in the liver cells. It is not certain how fatty liver occurs but could possibly be fat that is transported from other parts of the body into the liver.

Causes and higher incidence of fatty liver can include heavy alcohol consumption, extreme weight gain, diabetes mellitus, tuberculosis, gastric bypass surgery, use of corticosteroids.

Fatty liver can be diagnosed by the presence of an enlarged liver, elevated liver enzymes, biopsy of the liver, and imaging studies including ultrasound and CT.

On ultrasound images a fatty liver will appear bright in a ripple pattern. CT studies of the liver will present less dense than a normal liver when fatty liver occurs.

Simple fatty liver is not associated with other liver abnormalities however individuals who have fatty liver due to heavy alcohol consumption and continue to drink excessively can result with alcoholic hepatitis or alcoholic cirrhosis.

Fatty liver can occur in patients that do not drink excessively as well. Patients that are at a higher risk for developing fatty liver without excessive drinking include middle aged, significantly overweight, and diabetic individual. These individuals that have a fatty liver the liver can progress to the development of nonalcoholic steatohepatitis (NASH) or steatonecrosis or necrosis. It is possible that between 20-40% of grossly overweight individuals will develop NASH.

Treatment for fatty liver is related to it's cause. Obese individuals will benefit with weight loss. Heavy drinkers will benefit from discontinuing alcohol consumption. Patients with diabetes mellitus can benefit from controlling the diabetes with diet, drugs or insulin.

Mediastinal Teratoma

The above images are a PA Chest X-Ray and a CT Scan of the of the Chest revealing a Mediastinal Teratoma.

A teratoma is tumor consisting of different types of tissue, as of skin, hair, and muscle, caused by the development of independent germ or reproductive cells.

Mediastinal teratomas account for 7% of all teratomas. The mature type of these are benign and do not have potential to metastasize. These can be found in all age groups however they are most common in adults 20-40 years of age.

They are often asymptomatic. If symptoms due occur, they can include chest pain, cough, difficulty breathing, or symptoms similar to pneumonitis.

The treatment for mediastinal teratomas is typically just surgical removal of the cyst. The surgical procedure is the most often cause of complications.

Carotid Body Tumor

This image is a contrast-enhanced T1-weighted MRI of a right carotid body tumor overlying the right carotid bifucation.

The tumor is considered a glomus tumor which are part of the extra-adrenal neuroendocrine system. Glomus tumors most oftenly occur in the inner ear or the temporal bone. They are slow growing and not usually fatal.

Patients with the carotid body type of glomus tumor usually have symptoms such as hoarseness, dysphagia, vertigo, or paresis. They may present with a mobile, non tender lateral neck mass. They are believed to be caused by an overresponse to a change in the body's homeostasis.

CT with contrast, MRI with contrast, and angiography are best for diagnosing. Surgery is the preferred treatment. Patients that are not able to tolarate surgery may undergo radiation therapy or embolization. Embolization can be done prior to surgery because of the vascular nature of the tumors.

Pleomorphic Adenoma

This image is a coronal fat saturated T2-weighted MR image of a patient with a Pleomorphic adenoma. The mass seen involves the deep lobe of the parietal gland.

Pleomorphic adenoma is the most common type of benign salivary gland tumor. These are not typically life threatening however, surgical removal is recommended. Patients do not usually complain of symptoms. They are usually found during routine physical exams or palpated by the patient. CT or MRI studies are done to determine the proximity of the mass to the patient's facial nerve.

Hydrocephalus in Achondroplasia Patients

Achondroplasia is the cause of the most common type of dwarfism and is characterized by abnormally short stature with short arms and legs as well as an enlarged head. It is suggested that hydrocephalus in patients is related to stenosis of the sigmoid sinus. This results in a rise in intracranial venous pressure. The increased venous pressure impairs the absorption of cerebrospinal fluid. The build up of CSF in the brain results in hydrocephalus. This can be seen on MR venography.