Renal Cell Carcinoma – off the reservation

Unusual to see a presumed renal cell Ca this far off the reservation at presentation but it demonstrates a lot of the salient features of advanced disease.

  • Pulmonary Mets
  • Adrenal Regional Mets
  • Renal vein invasion
    • in this case into the normal variant retroaortic renal vein
  • Retroperitonal periaortic adenopathy

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Lung Mets and Malignant Effusion

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Knee Dislocation

A very uncommon but also very important event.  There is an association with popliteal artery injury, be it dissection or transection/laceration.

 

  • anterior and posterior dislocations most common
    • in my experience, posterior dislocations much more common, but sample bias is substantial because this is a rare event
  • structural disruption of the knee joint including cruciate ligaments and collateral ligaments, often with associated meniscal tears.
    • on MRI, the knee is usually “trashed”.
    • reports end up being lengthy because of the extent of injury.
  • Fractures common.
  • associated popliteal artery injury estimated at 30%.

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Glenoid Avulsion of the Glenohumeral Ligament (GAGL)

This is a fairly uncommon finding but the findings in this case are clearly posttraumatic. There is an impaction fracture the greater tuberosity and the labrum is essentially circumferentially torn even though the tear is not visible in the posterior labrum. Although not visible, it is still likely present. The glenoid avulsion of the glenohumeral ligament is clearly visible on the annotated images.

 


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