- The contrast enhanced CTs demonstrate low attenuation ascites around the liver and spleen due to extravasated urine.
-There is high attenuation contrast extravasation leaking from the bladder.

Bladder ruptures are usually classified as intraperitoneal versus extraperitoneal. An intraperitoneal rupture is caused by extreme pressure on a full bladder. The rupture occurs at the dome of the bladder, through the peritoneum, into the peritoneal cavity. An intraperitoneal rupture is more common in children because of the relative intra-abdominal position of the bladder. An extraperitoneal rupture is usually associated with fractures of the bony pelvis.


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Linguini Sign

There are high signal subglandular implants with central serpentine, low signal line.

Normal breast on MRI demonstrates high signal fat intensity interspersed with low signal fibrous tissue. The implant material is of higher signal than normal breast fatty tissue. The lines, termed “linguini sign,” within the implant capsule indicate intracapsular collapse.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=284349c3-afac-4ba1-b979-9347a55d241d

- Both breasts show many densely radiopaque nodules, compatible with free silicone residue from previously ruptured silicone implants.
-The newer left saline implant has ruptured and collapsed completely. The rounded density is the inflation port.
-The right saline implant is intact.

Discussion
Complications of breast implants include fibrous capsule formation (usual), capsule contracture, capsule herniation, intracapsular rupture, extracapsular rupture.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=ae82373a-f588-4487-99e7-ad48d559848b

-There is extracapsular rupture with several high density silicone nodules in the left axilla.
-The subglandular implants in both breasts are rounded up and demonstrate subtle irregularity in their curvature.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=dca074cc-8424-4ae4-9dbd-d302d247f675

The CT scans demonstrate a fractured hyoid bone, gas bubbles in an abscess producing mass effect, and narrowing of the airway.

This patient received a blow to the neck and noticed increased pain and difficulty swallowing. The hyoid bone is located between the mandible superiorly and the thyroid cartilage inferiorly. It is a “floating bone,” which is supported by strap muscles in the neck. In turn, it supports the root of the tongue, and allows for a wider range of motion, which may create a wider range of sounds.


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There is an air-fluid level evident in the large sliding esophageal hiatus hernia.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=711cae78-b173-48e2-989a-b7530cc3b42f

Hemothorax

-The CT shows an effusion with relatively high attenuation; hemorrhage has an attenuation exceeding 35 Hounsfield units (HU) when the blood is fresh, and reaching 70 HU with clotted blood.
-There is contrast in the hemothorax representing ongoing bleed into the thorax.
-A rib fracture is visualized.

A hemothorax is blood in the pleural space. Trauma is the most common cause for a hemothorax. Less common causes include pulmonary embolism, metastatic disease, anticoagulant therapy, leaking aortic aneurysm.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=7e7cde70-699d-4d26-8f9b-30752a17e137

Hemopericardium

-The fat attenuation linear density represents epicardial fat between the pericardial space and the myocardium.

The CT shows blood attenuation fluid surrounding the heart in the pericardial sac.

Hemopericardium refers to an accumulation of blood in the pericardial sac of the heart. Causes include spontaneous trauma versus iatrogenic trauma. Hemopericardium may cause cardiac tamponade.

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=fd246f06-b01b-4074-9fc9-8e239718618a

Glass Shards in the GI Tract

Patient 1: This patient presents with radiopaque densities in the descending colon on abdominal plain film and axial CT scan. This patient swallowed shattered glass.
Patient 2: This patient presents with radiopaque densities in the ascending, transverse, and descending colon on abdominal plain film. This patient swallowed fragments of a glass lightbulb.

Discussion
Psych patients and/or prison inmates may purposefully swallow foreign bodies. Not all glass is radiopaque. It is the lead in older glass that makes it radiopaque. If there is a high clinical suspicion for swallowed glass, and no glass is visible on abdominal plain film, a gastrograffin GI study may be helpful. Barium should not be used due to the possibility of the glass causing GI tract perforation.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=295d40f1-d9bb-49a7-be76-90846138b0db

Gallstone Ileus on CT Scans

-This CT demonstrates the classic Rigler’s Triad of gallstone ileus: Pneumobilia (air in the biliary tract), low small bowel obstruction with distended small bowel loops, and an impacted gallstone in the terminal ileum.
-Discussion
Gallstone ileus is the name given to the mechanical small bowel obstruction caused by a gallstone impacting in the terminal ileum. The gallstone passes through a cholecystoduodenal fistula, travels the length of the small bowel, and then obstructs just proximal to the ileocecal valve. It is an unusual complication of cholecystolithiasis and chronic cholecystitis.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=c1310251-d7d5-47e3-897d-e64cef4d2f56

Pneumoperitoneum

-The CXR demonstrates crescentic lucent air collections below both hemidiaphragms. This is the classic appearance for free peritoneal air on upright views.
-Note that the air outlines the inferior border of the diaphragms and the superior border of the liver.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=bae18cd6-95ae-4ee3-abd8-b5ceaaa715eb

Plantar Fasciitis

-The sagittal STIR (edema sensitive) MR image shows a thickened plantar fascia with edema. Contrast this with the thin fascia seen on the normal sagittal view.
-The coronal PD (proton density) MR image also shows thickening and increased signal in the fascia.

Discussion
When patient's present to a doctor complaining of heel pain, plantar fasciitis is the most common cause. It is caused by repetitive microtrauma and is common in runners.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=d9066408-e848-453f-a2dd-ecbe3b9786d7

Osteomyelitis of the Distal Phalanx on Plain Films

This patient demonstrates soft tissue swelling and bone destruction of the distal phalanx of the great toe due to osteomyelitis. There is unrelated flattening and sclerosis of the second and third metatarsal heads due to healed avascular necrosis (AVN).

Discussion
This patient was on systemic steroids, which predisposes to both osteomyelitis and AVN. Osteomyelitis may first present with soft tissue swelling with or without radiolucent gas collections. Later, lytic destruction of the underlying bone may occur. Common causative organisms include Clostridia, E. Coli, Streptococci, and Bacteroides. Osteomyelitis is more frequent in patients with arterial disease, diabetes, and patients on systemic steroids.


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Neuropathic Arthritis / Charcot Foot

-There is preservation of bone mineral density.
-There is osseous fragmentation, midfoot fractures, and destruction of multiple tarsometatarsal joints.

Discussion
Neuropathic arthritis is caused by chronic repetitive trauma to insensitive joints. Underlying causes include diabetes, steroid use, trauma, alcoholism, multiple sclerosis, spina bifida, and syringomyelia. The radiologic findings are frequently discussed at the “6 D’s:” Density i.e. bone density maintained, Dislocation, Debris, Distention i.e. soft tissue swelling and joint effusions, Destruction, Disorganization.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=001e927a-d1a5-417a-a4e1-954b594ef9ea

Lisfranc Fracture

-This patient demonstrates the medial cortical margin of the 2nd metatarsal base is malaligned with the medial margin of the middle cuneiform, termed a Lisfranc fracture.
-This is caused by severe plantar flexion of the foot.
-There are divergent and homolateral types.


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Jones Fracture

Findings
-This patient demonstrates a transverse fracture line at the base of the 5th metatarsal, called a Jones fracture.
-The fracture is located 1.5 – 2.5 cm from the proximal aspect of the 5th metatarsal.
-Typically caused by an inversion injury.
-Associated with a high incidence of non-union due to tenuous blood supply.


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Lover's Fracture

Findings

-This patient demonstrates a fracture through the calcaneus and a vertebral compression fracture at the thoracolumbar junction.

-This combination is called a “lover’s” fracture and is caused by axial loading (i.e. lover jumping from a window to escape an enraged spouse)

-There are retropulsed vertebral body fragments in the spinal canal, which can lead to neurologic compromise.

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=3e7aa04d-020a-401b-9bf2-f3558392e29b

Medullary Infarcts on Plain Films

Findings
-Medullary infarcts occur at the metaphyses.
-They are frequently multiple.
-They usually show well-defined dense geographic borders.
-They are frequently seen in patients on systemic steroids and sickle cell patients.


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Femoral Hernia with Small Bowel Obstruction on CT Scans

Findings

The CT scans demonstrate a bowel loop in the femoral canal with proximal small bowel dilatation.

Discussion

A femoral hernia lies in the femoral canal, medial to the femoral vein. Because of the narrowness of the femoral ring (the opening that forms the neck of a femoral hernia), it is more likely than an inguinal hernia to become incarcerated. Femoral hernias are most common in elderly women, typically presenting as a groin lump. The incidence of strangulation in femoral hernias is high.

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=431ef879-e8eb-4b25-85c2-ac1dfba5a398

Epidural Hemorrhage

Findings
The CT scans show a lens-shaped, biconvex high attenuation collection in the posterior left parietal lobe exerting mass effect.

Discussion
Acute bleeds present with high attenuation on CT. Epidural hematomas are due to traumatic head injuries which causes bleeding between the inner table of the skull and the dura. The majority are in the temporo-parietal region where a skull fracture causes damage to the middle meningeal artery or one of its branches. EDHs may cross the midline but do not cross suture lines.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=c1634e61-5022-4bf4-8648-111c7af88cc3

Findings
The CT scans demonstrate a left frontal epidural hematoma.

Discussion
Epidural hematomas arise in the potential space between the dura and the skull and do not cross sutural margins; the bleeding is mostly due to rupture of the middle meningeal artery. The major cause for EDH is trauma and skull fractures are present in 75 to 95 percent of patients. Epidural bleeds produce a bi-convex (lens-shaped) hematoma on CT because the collection is limited by dural attachments at the cranial sutures.


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Misplaced ETT down Right Mainstem Bronchus on CXR

Findings
-The radiograph demonstrates the endotrachial tube in the right mainstem bronchus
-The right lung is hyperinflated with resultant flattening of the right hemidiaphragm.
-The left lung is collapsed with resultant elevation of the left hemidiaphragm and leftward shift of the mediastinum.


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Fracture of the Radial Head with Effusion on Plain Films

Findings
-Frontal view: There is a subtle vertical fracture through the radial head.
-Lateral view: The anterior fat pad is displaced anteriorly. The posterior fat pad is visible. These indicate a joint effusion.

Discussion
The anterior fat pad is normally visualized hugging the anterior cortex of the distal humerus. The posterior fat pad is not seen on normal views. Anterior displacement of the anterior fat pad and visualization of the posterior fat pad are compatible with a joint effusion. Radial head fractures may be extremely difficult to detect on plain film. In the setting of acute trauma, if an elbow joint effusion is present, the presumption should be that a radial head fracture is present, even if the fracture line is not visible.


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Comminuted Fracture of Distal Humerus

Findings
This patient presents with a comminuted fracture of the distal humerus from bullet shrapnel.

Discussion
A plate with screws was inplanted into this patient's arm for initial fixation of the fracture.


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Elbow: Biceps Tendon Rupture on MRI Scan

Findings
-The T2 MR image with fat saturation shows a ruptured distal biceps brachii tendon.
-The tendon is wavy and there is edema in the cubital fossa.

Discussion
Biceps tendon ruptures usually occur due to trauma from a forceful flexion of the elbow. Visualization the ends of the tendons is crucial for preoperative planning.


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http://www.google.com.eg/imgres?imgurl=http://www.scielo.br/img/revistas/bdj/v18n1/a15fig04.jpg&imgrefurl=http://www.scielo.br/scielo.php%3Fscript%3Dsci_arttext%26pid%3DS0103-64402007000100016&usg=__u_bGaasFJYYd2W2dBdHvFGEfXUE=&h=528&w=812&sz=75&hl=ar&start=17&itbs=1&tbnid=Hp7ZgZWD8hqhhM:&tbnh=94&tbnw=144&prev=/images%3Fq%3DTMJ%2B3D%2BCT%26hl%3Dar%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

http://www.google.com.eg/imgres?imgurl=http://www.scielo.br/img/revistas/bdj/v18n1/a15fig04.jpg&imgrefurl=http://www.scielo.br/scielo.php%3Fscript%3Dsci_arttext%26pid%3DS0103-64402007000100016&usg=__u_bGaasFJYYd2W2dBdHvFGEfXUE=&h=528&w=812&sz=75&hl=ar&start=17&itbs=1&tbnid=Hp7ZgZWD8hqhhM:&tbnh=94&tbnw=144&prev=/images%3Fq%3DTMJ%2B3D%2BCT%26hl%3Dar%26sa%3DG%26gbv%3D2%26tbs%3Disch:1

-The chest radiograph appearances of pneumonia are not specific, and frank lobar consolidation as seen in adults and older children is rare. More commonly, there is coarse opacity of one or more regions of the lung parenchyma. However, these appearances can also be seen with retained fetal lung fluid, meconium aspiration, aspiration of gastric contents, and pulmonary haemorrhage. Pleural effusions are not uncommon in infection, but again may be seen with other conditions.

-Group B Streptococcus can have an appearance similar to Respiratory Distress Syndrome (Surfactant Deficiency), although the granulation is typically more coarse.

http://www.adhb.govt.nz/newborn/TeachingResources/Radiology/LungParenchyma.htm

-Transient Tachypnoea of the Newborn (TTN, also called Retained Fetal Lung Fluid or "Wet Lung") is a diagnosis of exclusion.

-Typical radiologic features are ill-defined but include:

1-Increased central vascular markings ("star-burst" appearance)

2-Hyperaeration

3-Evidence of interstitial and pleural fluid

4-Prominent interlobar fissures

5-Cardiomegaly

-Because the symptoms and radiological features are non-specific, infection should be considered in the differential diagnosis. Typically, respiratory symptoms resolve within the first 24-hours of life, but occasionally can persist longer.

http://www.adhb.govt.nz/newborn/TeachingResources/Radiology/LungParenchyma.htm

- Respiratory Distress Syndrome (RDS) is a clinical diagnosis but one which is often interchanged with the terms Hyaline Membrane Disease (a pathological diagnosis) and Surfactant Deficiency (a term describing the typical appearances on radiographs of infants with RDS).

- The typical radiological features of Surfactant Deficiency are:

1-Small volume lungs

2-Homogenous "ground glass" opacity

3-Air bronchograms

-The differential diagnosis includes:

1-Pneumonia (particularly Group B Streptococcus)

2-Retained Fetal Lung Fluid/TTN

http://www.adhb.govt.nz/newborn/TeachingResources/Radiology/LungParenchyma.htm

Diverticulitis: Pelvic Abscess with Fistulae

Findings
There is a large gas containing pelvic abscess with adjacent tiny collections of air and contrast in fistulous tracts.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Diverticulitis of the Sigmoid Colon with Fat Stranding on CT Scan

Findings
There are diverticula and thickening of the walls of the sigmoid colon with significant surrounding fat stranding.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Diverticulitis of the Sigmoid Colon with Extraluminal Air on CT Scan

Findings
There are diverticula and thickening of the walls of the sigmoid colon with an adjacent extraluminal air pocket suggestive of local perforation and/or abscess formation.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=f5d49a02-b286-46dc-bb4c-f44e3d3840fa

Diverticulitis of the Sigmoid Colon with Colovesical Fistula on CT Scans

Findings
-The sigmoid shows diverticula and is attached to the dome of the bladder.
-A fistulous tract is seen filled with air and contrast between the sigmoid and the bladder.
-There is air and colonic contrast within the bladder lumen.

Discussion
A fistula between the bladder and colon may occur due to a number of diseases, most notably colon cancer, bladder cancer, Crohn’s disease, and diverticulitis. CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=672446a7-0e2b-4311-bc2d-792861e6a34e

Findings
There are diverticula and thickening of the walls of the sigmoid colon compatible with uncomplicated diverticulitis. Notice the absence of surrounding fat stranding.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=9156501b-c790-4b8a-ae9f-b06546e8e5b6

Findings
-This patient presents with an abnormal position of a nasogastric tube (NGT) overlying the left hemithorax.
-This patient demonstrates normally located chest tube and endotrachial tube (ETT).

Discussion
This patient suffered a rupture of the left hemidiaphragm secondary to a motor vehicle accident. The NGT is correctly placed in the stomach, but the stomach is now located in the left chest.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=0513b7be-2271-4dc0-b365-1477cc2bf8ca

Findings
This patient presents with a sternomanubrial dislocation as demonstrated: There is posterior dislocation of the body of the sternum in relation to the manubrium of the sternum.

Discussion
Sternomanubrial dislocation is a rare injury, typically caused by high velocity trauma, e.g. MVA. There is a significant association with injury to the great vessels.



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Findings
This patient is S/P fractures of the medial and lateral malleoli with internal fixation. There are now fractured buttress plate screws as labeled.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=b27fd9a5-b4b7-48d4-bddc-2e784189b7ef

Bullets and Shrapnel in the Chest on Plain Film and CT Scans

Findings
-This patient presents with two 9 mm bullets as outlined on plain film and CT scans: Bullet 1 is just deep to the ribs, bullet 2 is in the superficial soft tissues anterior to the sternum.

Discussion
-This patient was radiographed on a trauma backboard. When locating a foreign body on plain film, orthogonal views (views at 90 degrees to each other) are mandatory.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=0b5aab3a-1116-4bad-9ddd-80ddbda0973c

Bowel Wall Hemorrhage and Obstruction from Coumadin Overdose on CT Scans

Findings
-The proximal small bowel is enlarged with high-density intramural thickening and regularly thickened folds.
-The stomach is dilated with normal wall thickness. The distal small bowel is normal in caliber.

Discussion
This patient overdosed on coumadin and the findings are due to a mural hemorrhage in the duodenum and proximal jejunum causing partial gastric outlet obstruction.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=2ff7119e-48ac-4e6b-b6b3-9b73cddf1791

Bowel Ischemia with Pneumatosis Coli and Portal Venous Gas on CT scans

Findings
-The contrast enhanced CTs show air in the bowel wall and portal venous system, which is classic for bowel ischemia and necrosis.
-Note that some of the gas collections remain in the dependent portion of the bowel i.e. they are not intralumenal, but are trapped in the bowel wall.

Discussion
Interruption of blood flow to the bowel can result in bowel ischemia and necrosis. The CT findings include air in the bowel wall aka pneumatosis coli, mesenteric or portal venous gas, lack of bowel wall enhancement, increased enhancement of the thickened bowel wall, and/or bowel obstruction.


http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=8c961ba5-9a67-48e9-b8ca-3f1c1dd3b6e2

Findings

-The CXR shows aberrant air secondary to the perforated esophagus; subcutaneous emphysema and pneumomediastinum.

-There is widening of the mediastinum and a left pleural effusion.

-The BaSw demonstrates extensive extravasation of contrast material through the lower esophageal perforation.

Discussion

Boerhaave’s Syndrome, or “spontaneous” esophageal perforation, usually presents with a linear tear through the lower esophageal wall secondary to vomiting against a closed glottis. The patients are frequently inebriated. Aberrant air is the usual radiologic presentation; pneumomediastinum occurs first. The air then tracks into the neck, producing deep cervical emphysema, which may rupture, producing subcutaneous emphysema. The pneumomediastinum may rupture into the pleural space causing a life threatening pneumothorax. Mediastinitis is the usual clinical presentation. Reported mortality estimate is approximately 35%, making it the most lethal perforation of the GI tract.

http://eradiology.bidmc.harvard.edu/Classics/item.aspx?section=Emergency+Radiology&labelpk=33f0adab-853f-4010-a0e2-0756b3f1eac5&pk=cbff3b0e-f686-4e10-86ad-0bf68d557b89

ganglion cyst,

Sagittal STIR image obtained in 28-year-old woman reveals homogeneously hyperintense bilobular mass in Kager's fat pad consistent with ganglion cyst, arising from ankle joint and herniating into Kager's fat pad.


http://www.ajronline.org/cgi/content/full/182/1/147/FIG21

Extraskeletal myxoid chondrosarcomas. Lateral ankle radiograph (A) and axial fat-suppressed T2-weighted image (B) obtained in 42-year-old man with extraskeletal myxoid chondrosarcoma of Kager's fat pad show large mass in fat pad. On radiograph, soft-tissue mass (asterisks, A) is shown to be completely obliterating fat pad and eroding calcaneus (arrow, A). T2-weighted image (B) reveals large mass with predominantly high signal intensity and macrolobulated margins.

http://www.ajronline.org/cgi/content/full/182/1/147/FIG18