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Case Notes

History

50 year old male with acute right knee pain.

Exam

4 views R knee

Prior Study

none

Dicom

Findings

You scored: 0 / 25

Technique	Correct Answer	Your Answer
The exam is over or under penetrated.	No	NA
The exam may be limited by overlying structures or soft tissues, body habitus, patient positioning, support devices, or motion.	No	NA
The area of concern is indicated by the patient, technologist, or provider.	Yes	NA
The area of concern is included on the exam.	Yes	NA

Soft Tissues	Correct Answer	Your Answer
There is soft tissue swelling, indistinctness of fat/muscle planes, gas, or laceration in the area of clinical concern.	No	NA
There is an effusion, fat pad displacement, or fat fluid level.	No	NA
There is a radiodense or lucent foreign body.	No	NA
There are other densities, calcifications, post-surgical changes, or support devices in the soft tissues.	No	NA

Bone	Correct Answer	Your Answer
There is a break or interruption of the continuity of the cortical or cancellous bone with or without displacement of a fracture fragment.	Yes	NA
There is abnormal angulation of the cortical surface relative to the normal cortex.	Yes	NA
There is linear or irregular lucency, or increased density, cortical depression, flattening, or collapse with or without cortical disruption or thickening, which may be from a compression or impaction fracture, stress or insufficiency fracture, osteonecrosis, or other fracture.	Yes	NA
There is disruption of commonly recognized anatomical lines (e.g. iliopectineal) or structures (e.g. sacral foraminal or arcuate lines).	No	NA
There is a displaced fragment which may be from avulsion by a tendon, or joint capsule or from a comminuted or other fracture.	Yes	NA
There is periosteal or endosteal reaction which could indicate a healing or subacute fracture or other abnormality.	No	NA
The stress trabeculae or other trabeculae of the cancellous bone are interrupted or otherwise abnormal.	No	NA
There is subchondral abnormality (lucencies, increased density, erosion) with or without cortical disruption or thickening which may be from osteonecrosis, osteochondritis dissecans, osteochondral fracture, inflammation, infection, or other abnormality.	Yes	NA
There is/are focal or multifocal lytic/lucent, blastic/sclerotic or mixed density lesion(s) or other abnormality.	No	NA
Overall bone density is increased or decreased.	No	NA

Joints and Alignment	Correct Answer	Your Answer
There is an effusion, fat pad displacement, or fat fluid level.	No	NA
There is an intra-articular loose body or chondrocalcinosis.	No	NA
The joint is widened, narrowed, dislocated, malaligned, or incongruent.	No	NA
The subchondral or intra-capsular bone is fractured, interrupted, flattened, compressed, impacted, or otherwise abnormal.	Yes	NA
There is increased, decreased, or mixed density in subchondral bone.	No	NA

Other Findings	Correct Answer	Your Answer
There are degenerative changes, developmental changes or other anatomic variants, or other existing conditions that may or may not be contributing to symptoms which can or should be further evaluated non-emergently or are otherwise incidental.	Yes	NA
The remainder of the exam is abnormal for age.	No	NA

Impression

Expert Answer

There is an osteochondral defect of the right medial femoral condyle with an adjacent fragment from osteochondritis dissecans.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Verbal communication of findings of osteochondritis dissecans.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer