This 13-year-old female cross country runner presents with l | Figure 1

Case Presentation

This 13-year-old female cross country runner presents with left-sided anterolateral pain superior to the iliac crest. How many observations can you make from the two images? Image 1 is a fat-weighted coronal T1 image, and image 2 is a coronal proton-density image with fat suppression. #PelvisMRI #MRI #Radiology #RadRes

Similar cases

Sagittal (image 1), coronal (image 2), axial (image 3), and oblique coronal (image 4) contrast-enhanced CT in an adolescent with chest pain shows pericardial fat necrosis. Paracardial fat necrosis is a rarely described condition. Patients described sudden onset of severe pleuritic chest pain. The cause is unknown and may be similar to omental infarct.](https://app.figure1.com/case-detail/0085c331-072a-4f26-a535-6fb17d8c4252)

This 22-year-old has medial pain from a fall. You are shown three sagittal images (images 1-3): a T1, a simple 2D gradient-echo, and a proton density with fat suppression frequency selective. You are also shown a coronal proton density fat suppression image (image 4). Your first step is to establish if this is a meniscus tear. Spoiler alert: it’s not. What are your next steps? #kneemri #mri #radiology #radres](https://app.figure1.com/case-detail/1dd88bd9-ed88-445e-adc6-1e4284fec130)

history of a fall. T1 fat sat coronal MRI arthrogram. What's wrong?](https://app.figure1.com/case-detail/28a1f2cf-2851-425c-b994-fa3053a2f447)

MRI fat suppression series must be taken into account when reporting on different scenarios. Frequency specific fat suppression techniques (SPIR,SPAIR, Fat Sat, Water Excitation, etc) applied to series will only suppress out fat or fat like substances. Inversion Recovery technique, called STIR, will suppress any tissues that have a short T1 like fat. STIR is used extensively in MSK imaging in particular, but be aware it will suppress out Gd enhanced tissues, Chronic blood (methaemoglobin) and Melanin. Not knowing this may lead to misinterpretation of tissue types.
1st images shows some chronic subdural blood - the rim is bright on T1 series (compare with scalp fat), but stays bright on the T1 Fat Sat. Note how it suppresses out on the STIR (like the scalp fat)
2nd Images show an intra-ocular melanoma. Note how it stays bright on the T1 fat Sat, but suppresses out on the coronal STIR
3rd Images show Gadolineum enhancment of the rim of a brain neoplasm on T1 series, but note how it suppresses dark on the STIR post gadolineum
All the examples above could be misinterpreted as "fat" after a STIR series, so be aware of what type of Fat suppression series your techs are using - especially with MSK series](https://app.figure1.com/case-detail/54ad6e50-a102-4b4d-9ea2-9bdb98c039f8)

Additional Cases

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)