MedPix Medical Image Database COW - Case of the Week Case Contributor: Stephen T Sears Affiliation: Naval Medical Center San Diego

MedPix No: 2644 - History Pt Demographics: Age = 21 y.o. Gender = man Patient with right wrist pain after a fall while snowboarding. Downloaded by (-1)

MedPix No: 2644 - EXAM & LABS Right *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. Downloaded by (-1)

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. Downloaded by (-1)

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. Downloaded by (-1)

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. Downloaded by (-1)

FINDINGS Plain 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 DIAGNOSIS What is your Differential Diagnosis?

Diagnosis: Scaphoid fracture Dx Confirmed by:

DISCUSSION