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Fracture of the Lateral Process of the Talus: The Small Ankle Fracture That Is Easy to Miss on X-ray

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A radiologist’s approach to persistent lateral ankle pain, subtle radiographic findings, CT diagnosis, differential diagnosis, treatment planning, and the emerging role of AI in musculoskeletal imaging When an “Ankle Sprain” Is Not an Ankle Sprain A man in his 30s presented with right lateral ankle pain three days after twisting his ankle. At first glance, this sounds like an ordinary ankle sprain. That is exactly where the diagnostic trap begins. In patients with an inversion-type ankle injury, attention naturally moves toward the lateral ligament complex, particularly the anterior talofibular ligament. If the initial radiograph does not show an obvious fracture, the injury may be labeled an ankle sprain. But the location of pain matters. When pain is concentrated just anterior and inferior to the distal fibula, particularly when it persists beyond what would be expected for an uncomplicated sprain, the lateral process of the talus deserves deliberate inspection. A small osseous frag...
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Acute Myocardial Infarction on Chest CT: The Proximal LAD Occlusion and Subendocardial Perfusion Defect That Radiologists Must Not Miss

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  A Radiologist’s Guide to Recognizing Myocardial Ischemia on Contrast-enhanced CT Clinical Hook A man in his late 40s arrived with sudden chest pain. The initial clinical question was not necessarily “Can CT diagnose myocardial infarction?” In an emergency department, the more immediate concern in a patient with acute chest pain may be to exclude other life-threatening conditions such as aortic dissection, pulmonary embolism, or another acute thoracic process. But the CT contained a second, potentially decisive message. The myocardium was not enhancing uniformly. A relatively hypoenhancing region extended through the left ventricular anterior wall toward the apex, with involvement of the interventricular septal and apical inferior myocardial regions. More importantly, the myocardial abnormality followed a recognizable coronary distribution. At the same time, the proximal left anterior descending artery demonstrated occlusion associated with noncalcified plaque. The diagnosis was a...
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