We describe an unusual presentation of myeloperoxidase positive antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis managed by a multidisciplinary approach. A 75-year-old man gave a 3-week history of proximal lower limb weakness and exertional myalgia. His serum creatine kinase was normal and many of his non-specific symptoms suggested small vessel vasculitis. His investigations for common causes of muscle weakness were normal, and renal biopsy was normal despite haemoproteinuria. CT scan of the chest identified a pulmonary nodule of uncertain significance, not amenable to biopsy. MR scan of the thighs showed muscle oedema, and muscle biopsy confirmed typical features of vasculitis. Following high-dose corticosteroids his exertional myalgia quickly resolved and his normal mobility returned. Early immunosuppression is essential to improving clinical outcomes in ANCA-associated vasculitis, but diagnostic investigations often lack sensitivity.

Radiologists frequently interpret cross-sectional imaging of the spine in the setting of trauma. Mechanical stability of the traumatised spine is the single most important factor which guides further management. Several classification systems have been developed over the past to assist radiologists to judge the potentially unstable injuries. The radiologists are arguably most familiar with Denis system of classification which is based on injury morphology and mechanism. This system has been criticised for being too simple, not prognostically valuable and lack of consideration of patients' neurological status. AO (Arbeitsgemeinschaft für Osteosynthesefragen) and TLICS (Thoracolumbar Injury Classification and Severity Score ) classification systems are the next major evolutions which highlight the importance of the posterior ligamentous complex (PLC) and neurological status of the patients in predicting the potentially unstable fracture. The aim of this pictorial review is to familiarise radiologists with newer classification systems to improve their image interpretation skills and promote efficient communication with spinal surgeons. The pictorial examples are intended to illustrate the various injury types and how to classify them according to the aforementioned classification systems.