Imaging Case of the Week 317 Answer

The frontal wrist x-ray shows a triangular appearance of the lunate, causing the ‘Piece of Pie’ sign.

The lateral wrist x-ray showed a dislocated lunate.
In a lunate dislocation, it is the rotation of the lunate that causes a triangular appearance on the PA view.

Reference: Harwood-Nuss’ Clinical Practice of Emergency Medicine.