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he frequency of fractures of the lateral process of the talus (LPT) has markedly increased because of the expansion of snowboard activity. These lesions are difficult to diagnose, because they have aspecific signs, and standard radiographs do not show the fractures in 50% of cases. Sonography is used more and more in the assessment of ankle trauma, but it is rarely performed for detection of bone fractures. We report a case of a patient in which sonography directly showed an LPT fracture. Case ReportA 32-year-old man was admitted to the Emergency Department for acute right ankle pain that occurred the day before during snowboarding. He had forceful movement of eversion and external rotation of the ankle during a jump landing, followed by inability to bear weight and painful ankle swelling. Clinically, moderate swelling over the lateral malleolar and exquisite inframalleolar local tenderness were evident. Passive inversion and dorsal flexion of the foot were painful. Tests for instability of the ankle joint, including the anterior drawer test, were questionable because of severe pain and reflex muscle activation. Previous routine radiographic findings (anteroposterior [AP] and lateral views) were reported as negative.Because of pain at the external aspect of the ankle, sonography was performed to assess para-articular soft tissues and ligaments. Sonography was performed with commercially available equipment (HDI 5000; Philips Medical Systems, Bothell, WA) working with linear array transducers (frequency band, 5-12 MHz) and no standoff pad. Longitudinal and axial images obtained over the anterior talofibular and calcaneofibular ligaments showed normal aspects of both ligaments and no signs of tears (Fig. 1). A longitudinal image obtained over the

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Biliary stones are usually found in the gallbladder, but about 10-20% may spontaneously migrate into the common bile duct where they either remain trapped or migrate subsequently via the papilla of Vater into the duodenal lumen. In some cases, biliary stones may form de novo in the common bile duct because of local precipitating factors. We here present a spectacular case of huge gallstones impacted in the common bile duct (empierrement of the common bile duct) that led to the development of acute cholangitis with septic shock. Urgent nocturnal percutaneous cholangiography permitted biliary drainage and resolution of the cholangitis while the stones were secondarily removed surgically because of the large size of the stones.Acute suppurative cholangitis may be fatal unless adequate biliary drainage is obtained in a timely manner. The association of fever and rapid onset of jaundice in elderly patients should always make physicians think of cholangitis.

Most of the time, perioteal Ewing sarcoma is found in the diaphysis of the proximal extremities. It typically shows a monolamellar periosteal reaction with a Codman's triangle ( Figure 1A) over a subperiosteal soft tissue mass, which is sharply demarcated from the underlying cortical bone. Cortical scalloping and erosion are possible, but the tumor does not invade the cortical bone ( Figure 1B). Periosteal Ewing sarcoma doesn't show osseous or cartilaginous matrix calcifications.MRI is the best imaging modality to evaluate the tumor extent within the bone, the medullar cavity and the surrounding soft tissues. Medullary invasion is rare and should be suggested only when the marrow replacement is in continuity with the surface soft-tissue component. In our case there is a strict integrity of the cortex. FIGURE 1 Periosteal Ewing sarcoma: (A) right leg radiography, AP and lateral projections; (B) both legs MRI, SE T1 coronal postgadolinium.