Annular Pulley Rupture of the Toes: Expanding the Differential Diagnosis for Forefoot Pain with Novel MR Findings: A Case Report.

CASE: Herein is presented a case of rupture of the A2/A3 annular pulleys of the left second toe in a 33-year-old male patient after a snowboarding injury. The injury was detected on magnetic resonance imaging (MRI) 7 weeks after the initial trauma. The patient was treated conservatively, including toe splinting, with the patient returning to his asymptomatic preinjury baseline after 6 months. CONCLUSION: Annular pulley rupture of the toes is a novel cause of prolonged forefoot pain. Clinician awareness of this unique injury and its often subtle MRI findings may help avoid delays in appropriate diagnosis and treatment.

Emphysematous cystitis with extraperitoneal gas: new insights into pathogenesis via novel CT findings.

Emphysematous cystitis is a relatively rare disease entity characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging. Its disease mechanism is not well understood. A case of a diabetic patient with emphysematous cystitis is presented and is notable for the rare finding of extraperitoneal gas in the pelvis based on a review of 114 case reports. Herein we propose a distension-based mechanism with intramural bacterial seeding as the pathogenesis of emphysematous cystitis based on the patient's imaging and the disease's established associations with diabetes and E. coli. The ability to recognize extraperitoneal pelvic gas as a feature of emphysematous cystitis allowed prompt diagnosis. This facilitated early commencement of successful treatment in a diabetic patient in whom the diagnosis was not suspected clinically.