IMAGE OF THE WEEK 2014

IMAGE 1

 

GANGRENE

 

Figure 1: Plain x-ray of the ankle showing multiple pathologies as annonated in Figure 2.

(Click on image to enlarge)

Figure 2: Annotated plain x-ray image of the ankle of Figure 1 showing disused atrophy, arterial wall calcification and gas gangrene in soft tissue of the sole.

(Click on image to enlarge) 
   

 

 

Not everything in medicine necessarily requires an imaging investigation, in particular a plain x-ray.  However, sometimes they are undertaken for an alternative indication yet reveal findings one must understand and interpret, despite it perhaps being much more obvious clinically.

 

In addition, a single x-ray may reveal more than one pathology which are often related to the same underlying condition.

 

A classical example of this is a patient with long standing poorly controlled diabetes, with the multitude of complications which may be set this patient group.

For example,

  1. An ultrasound neck, may reveals a carotid artery stenosis (due to atherosclerosis) and an enlarged parathyroid gland ( from secondary hyperparathyroidism.
  2. A CT abdomen may demonstrate atrophic kidneys (diabetic microvascular disease) and the dense bony skeleton of renal osteodystrophy.
  3. A plain film of the foot revealing a Charcot’s joint (a result of diabetic neuropathy ) along with the profound digital artery calcification (due to atherosclerosis).
  4. Or as in this case, a diffusely abnormal texture to the bones of the foot due to disuse (Sudek’s ) atrophy along with multiple foci of gas in the soft tissue due to gangrene ( Figure 1 & 2).  This is a pre-amputation film in the extent of disease.

 

 

 

Images and text contributed by

Dr Ian Bickle, Department of Radiology,RIPAS Hospital

All images are copyrighted and property of RIPAS Hospital.

 

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