MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Stephen T SearsAffiliation: Naval Medical Center San Diego

MedPix No: 2644 - HistoryPt Demographics: Age = 21 y.o. Gender = manPatient with right wrist pain after a fall while snowboarding.

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MedPix No: 2644 - EXAM & LABSRight *snuff box* tenderness to palpation.

Right wrist

Plain film of the right wrist demonstrates scaphoid waist fracture with smooth margins and slight sclerosis of the proximal pole.

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Right Wrist plain film 2

There is a fracture of the scaphoid waist with slight displacement of the distal fragment, slight sclerosis of the proximal pole and widening of the scapholunate space.

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Rt Wrist T1 Pre GAD

There is a scaphoid waist fracture with anterior displacement of the distal fragment. The signal characteristics of the distal and proximal fragments are similar.

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Post Gad Right Wrist

Post gadolinium, increased enhancement is present in the distal pole, likely associated with hyperemia and edema, while the proximal pole does not enhance.

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FINDINGSPlain films demonstrate a scaphoid waist fracture with smooth margins, slight displacement of the distal fragment, and increased sclerosis of the proximal fragment. There is an increased scapholunate joint space consistent with disruption of the scapholunate ligament.MRI pre and post-gadolinium demonstrates scaphoid waist fracture with anterior displacement of the distal fragment, increased enhancement of the distal scaphoid fragment (likely from hyperemia and edema) and lack of enhancement in the proximal pole consistent with avascular necrosis.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?

Diagnosis: Scaphoid fractureDx Confirmed by:

DISCUSSION