Ángel Gómez-Cintrón, MD, MPH

03/20/2025

Accidents, moves and other unimportant life events have precluded adequate involvement in medical education and mentorship, but I’ve missed it greatly.

Today, as a Professor at UT Dell Medical School and radiologist at ARA, I’m focused on getting back to what I feel so passionate about - teaching and mentoring medical students, residents and young physicians through compassionate and quality patient care.

Don’t call it a comeback. 😉 Let’s do this! 💪

07/09/2024

Radiology Friends!

We received a lot of amazing submissions for this year! Now we need your help narrowing it down to the five speakers who will present at . Fast 5 Session voting is now open through July 22.

https://rsna.az1.qualtrics.com/jfe/form/SV_dbWFM3D2GHoNIvs

02/11/2024

The Four MRI Layers of Subacute Osteomyelitis (Brodie’s Abscess)!

1. Inner core of pus and necrotic tissue. High T2, low T1 signal intensity and no enhancement.

2. Thin layer of granulation tissue. Intermediate to high T1 and low T2 signal intensity with avid contrast enhancement. Known as the “penumbra sign” and highly specific for Brodie’s abscess.

3. Thin layer of fibrosis and sclerosis. Low T1 and T2 signal intensity. No contrast enhancement.

4. Thick outer layer of reactive edema. Low T1 and high T2 signal intensity. Variable patchy enhancement.

02/10/2024

Sternoclavicular Dislocation!

Easily missed on radiographs if you’re not paying attention! 👀👀👀

Usually related to indirect trauma to the chest. The dislocation can be anterior or posterior.

Anterior sternoclavicular dislocation is more common, less severe and easier to detect on physical examination. It is associated to pulmonary contusion, pneumothorax and rib fractures.

Posterior sternoclavicular dislocation is more severe yet occult on physical examination. It is associated to pulmonary pathology similar to anterior dislocation but also to mediastinal pathology including vascular and esophageal injury. In this patients, a CTA of the chest is of the essence, which thankfully is almost always obtained.

Obviously, sternoclavicular dislocations are much easier to identify on CT scan, but you want to keep an eye on those medial clavicles in the initial radiograph obtained on trauma patients!

02/08/2024

The Suprapatellar Complex! (or any other articular distention seen on radiographs).

In this lateral knee radiograph, we probably would include in our dictation: "large suprapatellar joint effusion", as denoted by the yellow arrows. But as you can see in the MRI images, this patient has severe synovial hypertrophy and active inflammation. There is no effusion (fluid - homogeneous high T2 signal intensity and no enhancement) in this knee even though we called it an effusion on radiograph. If you try to aspirate this knee, you won't get any fluid aspirate at all. In fact, we did a core biopsy of the inflamed synovium for diagnostic purposes.

That's the reason some radiologists favor the term "supra patellar complex" instead of effusion in their radiographs dictation as we can't know for sure if the distention of the articulation is fluid (synovial fluid or blood) vs. synovial hypertrophy or an intra articular mass (there are not many of this thankfully!).

Just a simple teaching point about joint distention in radiographs - it's not always a joint effusion!

This patient had exacerbation of an inflammatory arthropathy (RA).

12/27/2023

Intraosseous Epidermal Inclusion Cyst!

The differential diagnosis for a finger distal phalanx intraosseous lesion usually includes metastasis, enchondroma, glomus tumor and epidermal inclusion cyst. Subungual exostosis and keratoacanthoma are less common.  

Epidermal inclusion cyst is thought to be caused by extension of an adjacent subungual soft tissue epidermal cyst into the bone. Because this is a benign and chronic process, the lesion has well defined sclerotic borders and a very narrow zone of transition in radiographs. On MRI, the diagnostic hallmark is intralesional high T1 signal intensity due to proteinaceous content. It also shows peripheral contrast enhancement and high T2 signal intensity. Sometimes we can see surrounding edema and inflammation related to cyst rupture.

Glomus tumors, a benign hamartoma, have low intralesional T1 signal intensity and diffuse and avid enhancement.

Enchondromas are common in the bones of the hand and usually show radiographic nonaggressive features, endosteal scalloping and may have chondroid matrix.

Metastasis most often looks aggressive with ill-defined borders and associated periosteal reaction. Lung endobronchial tumors represent up to 40% of these metastasis (in case you see this on a test). In the past, the differential diagnosis of a distal phalanx lesion would include tuberculous dactylitis, also known as Spina Ventosa.

12/22/2023

Adhesive Capsulitis of the Hip (Frozen Hip)!

Much less prevalent than the analogous adhesive capsulitis of the shoulder, but with similar symptoms of decreased joint range of motion and pain. Usually sequelae from prior joint inflammation and synovitis which ends up with capsular thickening. In general terms, the hip capsule should measure less than 6mm. In this particular case, the joint capsule measured 1.2cm!

Joint capsule thickening is not specific for adhesive capsulitis of the hip and can be seen associated to other conditions such as arthropathies and femoral acetabular impingement.

08/13/2023

Basics of MSK Radiology. Shoulder radiographs views and anatomy.

Basic shoulder anatomy as evaluated in the six most common shoulder x-ray views.

05/31/2023

I’ve been working as an ER Radiologist for 1 1/2 years. It’s been a great experience! However and like most, I was attracted to ER work by the one week on, two weeks off deal.

But is this lifestyle right for you? Here is my honest take on the topic.

Lately, many young radiologists are choosing to work as ER radiologists working the evening and overnight shifts. It’s appealing with a schedule of one week ...