In the past decade, new clinical and imaging criteria have vastly improved the diagnosis and outcome of patients with seronegative spondyloarthritis (SpA). It is estimated that up to 30% of patients with SpA may exhibit predominant (or only) peripheral manifestations of SpA. Lack of awareness can lead to a diagnostic delay of up to 8–9 years which can lead to significant patient morbidity. It is, therefore, essential to diagnose and treat SpA as early as possible. The aim of this pictorial review is to emphasize the important aspects of current peripheral SpA classification system and demonstrates the imaging findings related to peripheral SpA. Patients referred for imaging of peripheral joints can be from a wide referral source. Recognizing and reporting imaging features suggestive of peripheral SpA will allow appropriate and timely specialist referral with the aim of avoiding treatment delay.
Clinicians are commonly faced with patients presenting with a solitary palpable soft tissue mass. Most soft tissue lesions are benign, and not every mass is due to a neoplastic process. Many pathologies can mimic a malignant tumor. Despite appropriate clinicoradiologic assessment, these lesions can be mistaken for a soft tissue sarcoma and can lead to multiple investigations or an intervention, inconveniencing patients and leading to an increased health care cost. With the relevant clinical history, clinical examination, and specific imaging characteristics, the diagnosis can be narrowed. We present a pictorial review of soft tissue sarcoma mimics with guidance on appropriate differential diagnoses.
Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks’ gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients’ pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.
The presentation of unilateral leg swelling is commonly encountered clinical practice, with deep vein thrombosis (DVT) often raised as the main diagnosis. Not infrequently, and at times unexpectedly, a different pathology can be encountered. It is important to be aware of other causes of the unilateral swollen leg to avoid unnecessary anticoagulation and potential missed diagnosis. This article provides a systematic approach, with a review of the imaging characteristics, of the most common etiologies that can cause unilateral leg swelling mimicking a DVT.
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