Sikander Ali Khan, MD

 A 23-year-old male with a history of a fall on dorsiflexed right wrist. On examination, he had tenderness and mild swelling over wrist.

. LAT View. Lunate seen displaced and angulated volarly giving appearance of spilled teacup.

 CT: Reformatted sagital images. Lunate seen displaced and angulated volarly giving appearance of spilled teacup.

. CT: Reformatted coronal images. This also shows fracture of ulnar styloid process.

 AP radiograph - dislocation is often overlooked. Disruption of the normally smooth line made by tracing the proximal articular surfaces of the hamate and capitates.

Lateral radiograph - lunate seen displaced and angulated volarly giving appearance of Spilled teacup.

Plain film is normally sufficient to diagnose the dislocation. However CT plays an important role in assessing for associated occult fractures; the most common and important being scaphoid fracture.

 Lunate dislocations is an uncommon traumatic wrist injury that require prompt management and surgical repair. Lunate dislocations typically occur with high energy trauma resulting in loading of a dorsiflexed wrist. Lunate dislocations are far less common than the less severe Perilunate dislocation.

Sikander Ali Khan, MD
Consultant Radiologist
Royal Commission Medical Center, Saudi Arabia

Articles

Lunate Dislocation

Clinical History: A 13-year-old female patient presented in the emergency department with severe abdominal pain. No proper history is available, but patient did have surgery in pelvis. On request of clinician CT scan with I/V contrast was performed.

Figure 1. Sagital image from plain CT showing dilated vagina with calculi.

Figure 2. Sagital image from plain CT showing dilated vagina with calculi.

Figure 3. Coronal image from contrast CT showing dilated uterus superior to urinary bladder.

Figure 4. Axial image from contrast CT showing dilated vagina with calculi posterior to urinary bladder.

Contrast CT scan findings: The vagina and uterus appear dilated and fluid filled. Multiple calculi are seen in the vagina. The dilated vagina is displacing the urinary bladder superiorly and compressing the rectum posterior. Surgical metallic staple is seen for pubic symphysis denoting previous surgery.

Discussion: Primary vaginal calculi are due to urinary leak into the vagina through various types of fistulae and are associated with vaginal obstruction and urinary stasis. [1] In the absence of obstruction and stasis of urine in the vagina, infection with urease-splitting bacteria alone, is also cited as an etiological factor for stone formation. [2]

1. Raghaviah NY, Devi AI. Primary vaginal stones. J Urol 1980: 123: 771-772.
2. Mahapatra TP, Rao MS, Sharma SK, Vaidyanathan S. Vesical calculi associated with Vesico vaginal fistulas - management considerations. J Urol 1986; 136: 94-95.

Sikander Ali Khan, MD, consultant radiologist, Royal Commission Medical Center, Saudi Arabia

A 13-year-old female presented in the ED with severe abdominal pain. No proper history is available, but patient did have surgery in pelvis. CT scan with I/V contrast was performed.

Sikander Ali Khan, MD

Articles

Lunate Dislocation

Vaginal Calculi

Pelvic Lipomatosis