Axial (image 1) and coronal (image 2) CT in a patient with r | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Axial (image 1) and coronal (image 2) CT in a patient with relapsing polychondritis shows diffuse calcification of the trachea (arrow) extending to the bronchi. There is also calcification of the anterior costal cartilage (arrowhead). Relapsing polychondritis is a degenerative disorder associated with recurrent inflammation of cartilage throughout the body. The ears are most commonly involved. However, ocular, nasal, and large airway involvement is also common. #ThoraxThursday #ThoracicThursday

A1 - Moderate joint effusion.
The most common disorders associated with abrupt effusion in an adolescent or child are patellar dislocation / relocation, cruciate injury, or juvenile idiopathic arthritis (JIA). However, when these are not present you should expand the search pattern. In this case, note the green arrows on images 4, 5, and 6. The arrows indicate the same focal cartilage defect in the sagittal, coronal, and axial perspectives.
In the case of skeletally immature children, we occasionally find that T1 data sets are very useful in showing the grey uniform thickness of the articular hyaline cartilage. In this case, the cartilage has shouldering, "bordered edges", and is absent of tiny linear focus of PD SPIR hyperintensity as seen within the epiphysis. There is also a very subtle thin dark line above the posterior horn lateral meniscus on the T1 data set. Cartilage defect is better shown on the sagittal PD SPIR and coronal T2 SPIR.
Although there is osseous edema, and stress response within the lateral tibial epiphysis, the overlying cartilage of the plateau is not disrupted. Furthermore, there is no discoid meniscus or meniscus tear.
As stated above, joint effusion in the pediatric age group can be associated with juvenile idiopathic arthritis. In this case, there is no synovial thickening.

Radiographs of the spine (image 1), left upper extremity (image 2), hand (image 3), and pelvis (image 4) show diffuse stippled epiphyses (arrow) involving nearly all visualized bones.
Teaching point
Chondrodysplasia punctata is a heterogeneous group of skeletal dysplasias characterized by punctate calcifications within cartilage, most prominently at the epiphyses. The stippling represents abnormal cartilage calcification and is most conspicuous in infancy, often decreasing or disappearing with age. The differential diagnosis includes genetic syndromes, metabolic disorders, and teratogenic exposures. Teratogenic causes include warfarin exposure, alcohol exposure, and other conditions affecting vitamin K metabolism.

59 yo Female with idiopathic chondromalacia patella involving midlevel facets and 'oblique fissure involving the upper lateral patellar facet appearing to extend over 50% of the cartilage thickness. No ligamentous or meniscal issues on clinical testing or imaging.
Family Dr. thinks it will be surgical, I'm not convinced. Poor recruitment of quads, especially VMO 2' to nerve injury. It has been a very long time since I have seen a patellar debridement.
Opinions on when surgical intervention is prudent?

bilateral floppy #Ear after #Relapsing-polychondritis. This very rare autoimmune disorder eats away the cartilage in his ribs, #Trachea and #Nose. Treated by high-dose #Prednisone. If I can think of a simple way to correct his lop-ears...? Most cartilage of helix and antihelix is replaced by fibrous tissue.

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.

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.

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.

A 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?