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What Does My Lab Test Report Indicate?
Question: Greetings,
I have attached some images and I am seeking an opinion before I go back to the doctor. I would greatly appreciate a radiologist to look at them and let me know what they see.
Many Thanks,
XXXX
I have attached some images and I am seeking an opinion before I go back to the doctor. I would greatly appreciate a radiologist to look at them and let me know what they see.
Many Thanks,
XXXX
Brief Answer:
Details given below
Detailed Answer:
Hi,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
Page 1 of 11 shows the left iliotibial band.
Page 2 of 11 shows different planes
Page 3 of 11 shows left knee joint
Page 4 of 11 blue arrow shows proximal ilio tibial band and red arrow shows left antero labral tear.
Page 5 of 11 red arrow shows anterior labral tear and blue arrow shows proximal iliotibial band.
Page 6 of 11 shows proximal iliotibial band
Page 7 of 11 Yellow arrow shows left inner thigh fold of skin.
Page 8 of 11 Yellow arrow shows upper inner left thigh and medial inguinal region showing vessels ans nerves and is normal. Red arrow shows left anterior labral tear.
Page 9 of 11 Orange arrow shows upper thigh inner side and is normal.
Page 10 of 11 Red arrow shows muscles in outer left thigh and is normal.
Page 11 of 11 Orange arrow shows muscle in inner thigh.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Details given below
Detailed Answer:
Hi,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
Page 1 of 11 shows the left iliotibial band.
Page 2 of 11 shows different planes
Page 3 of 11 shows left knee joint
Page 4 of 11 blue arrow shows proximal ilio tibial band and red arrow shows left antero labral tear.
Page 5 of 11 red arrow shows anterior labral tear and blue arrow shows proximal iliotibial band.
Page 6 of 11 shows proximal iliotibial band
Page 7 of 11 Yellow arrow shows left inner thigh fold of skin.
Page 8 of 11 Yellow arrow shows upper inner left thigh and medial inguinal region showing vessels ans nerves and is normal. Red arrow shows left anterior labral tear.
Page 9 of 11 Orange arrow shows upper thigh inner side and is normal.
Page 10 of 11 Red arrow shows muscles in outer left thigh and is normal.
Page 11 of 11 Orange arrow shows muscle in inner thigh.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. I have some other questions.
I am aware of the anatomy. I am also aware of the various planes (pg 2/11), as I linked them to show the area of concern.
Page 3 of 11 (with the yellow box) is definitely not the knee joint. It was taken from the same set as the other hip images. ??
I am aware that the blue arrow designates the ITB. It looks abnormal to me. Does it look abnormal to you?
I am surprised that you note the red arrow on slides 4 & 5 as a labral tear. That would be a gigantic labral tear! Isn't this the iliofemoral ligament? Isn't is supposed to be connected there?
I am aware that the yellow arrow on slide 8/11 is pointing at the fold... a placement error on my part. What I am wondering about is the dark shadow that surrounds the iliac and femoral veins. Is this an active or chronic hematoma?
I am aware of the anatomy. I am also aware of the various planes (pg 2/11), as I linked them to show the area of concern.
Page 3 of 11 (with the yellow box) is definitely not the knee joint. It was taken from the same set as the other hip images. ??
I am aware that the blue arrow designates the ITB. It looks abnormal to me. Does it look abnormal to you?
I am surprised that you note the red arrow on slides 4 & 5 as a labral tear. That would be a gigantic labral tear! Isn't this the iliofemoral ligament? Isn't is supposed to be connected there?
I am aware that the yellow arrow on slide 8/11 is pointing at the fold... a placement error on my part. What I am wondering about is the dark shadow that surrounds the iliac and femoral veins. Is this an active or chronic hematoma?
Brief Answer:
Request additional images of the hip joint to study the labral tear
Detailed Answer:
Hi,
Thanks for writing back with an update.
1. The yellow box page 3 is indeed the left hip joint. Sorry for the typing error which read knee joint and thanks for pointing it out.
2. The ITB is appearing lear in some images and it appears more on the normal side to me. If the ITB is seen as a dark line in most other images in the coronal plane, then it is normal.
3. In 4 and 5, what I meant is the consequence of your anterior labral tear on left side which in turn can cause such an appearance to the iliofemoral ligament region. The labral tear is itself not clearly visible and I have made an assumption that there is some pathology in that area which can be from the anterior labral tear.
4. The signal intensities aound the veins is more likely an artifact. I will not call it a hematoma.
5. I request you to please send me the ntire set of images if possible by uploading the DVD to a file sharing website like dropbox or google drive and sharing the download link. I will download and have a detailed look in my workstation, including the exact nature of anterior labral tear.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Request additional images of the hip joint to study the labral tear
Detailed Answer:
Hi,
Thanks for writing back with an update.
1. The yellow box page 3 is indeed the left hip joint. Sorry for the typing error which read knee joint and thanks for pointing it out.
2. The ITB is appearing lear in some images and it appears more on the normal side to me. If the ITB is seen as a dark line in most other images in the coronal plane, then it is normal.
3. In 4 and 5, what I meant is the consequence of your anterior labral tear on left side which in turn can cause such an appearance to the iliofemoral ligament region. The labral tear is itself not clearly visible and I have made an assumption that there is some pathology in that area which can be from the anterior labral tear.
4. The signal intensities aound the veins is more likely an artifact. I will not call it a hematoma.
5. I request you to please send me the ntire set of images if possible by uploading the DVD to a file sharing website like dropbox or google drive and sharing the download link. I will download and have a detailed look in my workstation, including the exact nature of anterior labral tear.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Above answer was peer-reviewed by :
Dr. Raju A.T
Greetings,
I apologize for taking so long to reply. It took a very long time to download the images. This is only about half of them all, but if you want other views, please let me know.and I'll see if I have them.
I don't understand why the outward muscular appearance (freak show) is not seen on the MRIs. Please let me know if you see something specific on the left side. I hope you enjoy a challenge.
You can view them here: https://drive.google.com/folderview?id=0B_o3UdMuIt7FQXYxNkZWZl9waWs&usp=sharing
I appreciate your time.
Best regards,
XXXX
I apologize for taking so long to reply. It took a very long time to download the images. This is only about half of them all, but if you want other views, please let me know.and I'll see if I have them.
I don't understand why the outward muscular appearance (freak show) is not seen on the MRIs. Please let me know if you see something specific on the left side. I hope you enjoy a challenge.
You can view them here: https://drive.google.com/folderview?id=0B_o3UdMuIt7FQXYxNkZWZl9waWs&usp=sharing
I appreciate your time.
Best regards,
XXXX
Brief Answer:
Please find answers to some of the questions in the following
Detailed Answer:
Hi XXXX, Greetings
Thanks for writing back with an update.
1. Delay in replying is due to inability to download the entire set of images because of technical errors displayed by google drive. I have been tryingto download the images shared by you on google drive. Sorry to say that even after 4 attempts, I have not been able to download the complete set, and Ihave been able to download 3 of the files. There is a "network failure" error being displayed during download and it gets aborted. Probably dropbox is a beter alternative file sharing website.
2. I have been able to download the following files
(i) MR Arthrogram
(ii) MRI questions 2
(iii) MRI sagittal question
Please find my observations on the files which have been downloaded
(i) MR Arthrogram shows contrast enhancement of the iliopsoas muscle which appears increased in signal intensity.
(ii) MRI questions 2
Page 1 of 5 shows the obturator externus muscle
Page 2 of 5 shows transverse iliofemoral ligament and laterally we have the gluteus minimus muscle. In between there is the rectus femoris muscle tendon which is not clearly visible.
Page 3 of 5 shows vastus lateralis muscle
Page 4 of 5 shows in red arrow part of iliofemoral ligament and yellow arrow is the hesd of femur with slight different appeaarance due to structuresoverlapping.
Page 5 of 5 shows page 4 findings
(iii) MRI sagittal question shows the adductor magnus muscle with vessels adjacent to that.
3. Sometimes there can be outward muscular appearance due to the muscle and fat around it. I am sorry that I have not understood what you mean by the freak show part. Request clarification please.
Hope some of the questions put in by you have been answered.
I welcome more questions if you have.
Regards,
Please find answers to some of the questions in the following
Detailed Answer:
Hi XXXX, Greetings
Thanks for writing back with an update.
1. Delay in replying is due to inability to download the entire set of images because of technical errors displayed by google drive. I have been tryingto download the images shared by you on google drive. Sorry to say that even after 4 attempts, I have not been able to download the complete set, and Ihave been able to download 3 of the files. There is a "network failure" error being displayed during download and it gets aborted. Probably dropbox is a beter alternative file sharing website.
2. I have been able to download the following files
(i) MR Arthrogram
(ii) MRI questions 2
(iii) MRI sagittal question
Please find my observations on the files which have been downloaded
(i) MR Arthrogram shows contrast enhancement of the iliopsoas muscle which appears increased in signal intensity.
(ii) MRI questions 2
Page 1 of 5 shows the obturator externus muscle
Page 2 of 5 shows transverse iliofemoral ligament and laterally we have the gluteus minimus muscle. In between there is the rectus femoris muscle tendon which is not clearly visible.
Page 3 of 5 shows vastus lateralis muscle
Page 4 of 5 shows in red arrow part of iliofemoral ligament and yellow arrow is the hesd of femur with slight different appeaarance due to structuresoverlapping.
Page 5 of 5 shows page 4 findings
(iii) MRI sagittal question shows the adductor magnus muscle with vessels adjacent to that.
3. Sometimes there can be outward muscular appearance due to the muscle and fat around it. I am sorry that I have not understood what you mean by the freak show part. Request clarification please.
Hope some of the questions put in by you have been answered.
I welcome more questions if you have.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you.
I am disappointed that you were unable to see the complete set. The data image system did not want to let me make a copy. I appreciate your explanations for what you could view.
This is a subacute/chronic issue - almost 2 years - from equestrian repetitive movement injury (rising trot in English riding) from continuing to ride for many years after I sublaxed my hip when I took a hard fall from a green horse.
I think there may be multiple issues that contribute to each other, so it has been challenging for the doctors to diagnose precisely.
The "freak show" was a side comment referring to the way my hip looks when it rotates outwardly. Rather than creasing at the trochanter, it creases well below and the top of the VL muscle bulges, and of course, with accompanying lateral pain.
I think that as time goes on, acute signal intensity decreases, making it harder to locate the injury/injuries. I am hoping someone will identify the problem and have an "ah-ha" moment.
Thank you for you time and consideration.
Best regards,
XXXX
I am disappointed that you were unable to see the complete set. The data image system did not want to let me make a copy. I appreciate your explanations for what you could view.
This is a subacute/chronic issue - almost 2 years - from equestrian repetitive movement injury (rising trot in English riding) from continuing to ride for many years after I sublaxed my hip when I took a hard fall from a green horse.
I think there may be multiple issues that contribute to each other, so it has been challenging for the doctors to diagnose precisely.
The "freak show" was a side comment referring to the way my hip looks when it rotates outwardly. Rather than creasing at the trochanter, it creases well below and the top of the VL muscle bulges, and of course, with accompanying lateral pain.
I think that as time goes on, acute signal intensity decreases, making it harder to locate the injury/injuries. I am hoping someone will identify the problem and have an "ah-ha" moment.
Thank you for you time and consideration.
Best regards,
XXXX
Brief Answer:
Wish you a healthy life and complete recovery
Detailed Answer:
Hi XXXX, Greetings
Thanks for writing back with an update.
1. Sorry to hear about your injury and hope you are making a good recovery. At times, the recovery can take a long durations because of acute and chronic injuries.
2. In chronic or low intensity injures, there is slow healing and it usually heals by fibrosis. Adequate rest is important for better healing and heavy physical activity involving the injured joint is to be avoided.
3. The freak show might be due to prominence of the muscles during abduction movement. There can be a nerve pinching or ligament impingement which is causing the pain when you love the leg.
4. When there is an acute injury involving muscles, then there is edema in muscles and the fibers can also get strained or there can be a tear. Full tears are easily noticeable but partial tears can be difficult to locate. In about 3 weeks the edema decreases and after 12 weeks the tissue repair is almost complete and the signal intensities come back to normal. The amount of healing varies with grade of injury.
5. In chronic injuries the edema is less in surrounding areas and the 12 weeks healing does not exist. Avoiding stressful activities can help minimise the pain.
If you are able to walk and flex the left hip joint with no significant joint movement restriction then your hip joint looks stable. The painful symptoms diuring outward movement however is probably from pinching of nerve or an impingement, which is occurring during the movement.
I wish you complete pain relief.
Regards,
Wish you a healthy life and complete recovery
Detailed Answer:
Hi XXXX, Greetings
Thanks for writing back with an update.
1. Sorry to hear about your injury and hope you are making a good recovery. At times, the recovery can take a long durations because of acute and chronic injuries.
2. In chronic or low intensity injures, there is slow healing and it usually heals by fibrosis. Adequate rest is important for better healing and heavy physical activity involving the injured joint is to be avoided.
3. The freak show might be due to prominence of the muscles during abduction movement. There can be a nerve pinching or ligament impingement which is causing the pain when you love the leg.
4. When there is an acute injury involving muscles, then there is edema in muscles and the fibers can also get strained or there can be a tear. Full tears are easily noticeable but partial tears can be difficult to locate. In about 3 weeks the edema decreases and after 12 weeks the tissue repair is almost complete and the signal intensities come back to normal. The amount of healing varies with grade of injury.
5. In chronic injuries the edema is less in surrounding areas and the 12 weeks healing does not exist. Avoiding stressful activities can help minimise the pain.
If you are able to walk and flex the left hip joint with no significant joint movement restriction then your hip joint looks stable. The painful symptoms diuring outward movement however is probably from pinching of nerve or an impingement, which is occurring during the movement.
I wish you complete pain relief.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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