RESUMEN
The authors present a case of monoarticular localized pigmented villonodular synovitis (PVNS) in a 7-year old girl. PVNS is a rare benign disease of the synovial tissue. It is especially rare in ankles of children, with only 15 cases reported in literature. The girl presented with swelling and pain in the left ankle since 4 weeks. The tentative diagnosis was made after a joint puncture and a MRI scan. A synovial mass with a brown-yellowish appearance was seen during the excisional biopsy. After removing the entire mass and without adjuvant therapy, no recurrence was detected after 12 months. As it is very rare in children, PVNS is easily misdiagnosed. Early diagnosis is important to prevent bone and cartilage damage. A review of the clinical, radiological and therapeutical features of PVNS are presented.
Asunto(s)
Articulación del Tobillo , Artrodesis/métodos , Disección/métodos , Edema , Membrana Sinovial/patología , Sinovitis Pigmentada Vellonodular , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/patología , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/cirugía , Artralgia/diagnóstico , Artralgia/etiología , Biopsia/métodos , Niño , Diagnóstico Diferencial , Errores Diagnósticos/prevención & control , Diagnóstico Precoz , Edema/diagnóstico , Edema/etiología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Sinovitis Pigmentada Vellonodular/diagnóstico , Sinovitis Pigmentada Vellonodular/fisiopatología , Sinovitis Pigmentada Vellonodular/cirugía , Resultado del TratamientoRESUMEN
A 66-year-old Caucasian female presented with insidious sciatic pain leading to an uncommon diagnosis of tuberculous osteomyelitis with unknown portal entry. The patient did not report a history of a previous tuberculosis (TB) infection and her chest X-ray was negative for TB. Considering TB in the differential diagnosis of a 'bone abscess', it is of paramount importance to come to a correct diagnosis. Conventional radiographs still remain the first-line imaging modality for evaluation of skeletal symptomatology. However, biopsies or aspirates are often needed to yield the definitive diagnosis. The lack of awareness of the potential extrapulmonary involvement of TB leads to an important delay in diagnosis and treatment. Antituberculous drugs should be started at the time of biopsy and continued during 12-18 months, due to poor drug penetration into osseous and fibrous tissues.
Asunto(s)
Osteomielitis/microbiología , Ciática/etiología , Tuberculosis/complicaciones , Anciano , Femenino , Humanos , Isquion/diagnóstico por imagen , Osteomielitis/diagnóstico , Ciática/diagnóstico , Tuberculosis/diagnósticoRESUMEN
BACKGROUND: Objective quantification of anatomical variations about the femur head-neck junction in pre-operative planning for surgical intervention in femoro-acetabular impingement is problematic, as no clear definition of average normal anatomy for a specific subject exists. METHODS: We have defined the normal-equivalent of a subject's anatomy by using a statistical shape model and geometric shape optimization for finding correspondences, while excluding the femoral head-neck junction during the fitting procedure. The presented technique was evaluated on a cohort of 20 patients. RESULTS: Difference in α-angle measurement between the actual morphology and the predicted normal-equivalent, averaged 1.3° (SD 1.7°) in the control group versus 8° (SD 7.3°) in the patient group (p < 0.05). CONCLUSIONS: Defining normal equivalent anatomy is effective in quantifying anatomical dysmorphism of the femoral head-neck junction and as such can improve presurgical analysis of patients diagnosed with femoro-acetabular impingement. Copyright © 2016 John Wiley & Sons, Ltd.
Asunto(s)
Pinzamiento Femoroacetabular/cirugía , Cabeza Femoral/cirugía , Cuello Femoral/cirugía , Acetábulo/cirugía , Adolescente , Adulto , Algoritmos , Estudios de Cohortes , Fémur/cirugía , Articulación de la Cadera/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Modelos Estadísticos , Cirugía Asistida por Computador , Adulto JovenRESUMEN
BACKGROUND: Radiographic features specifically related to the occurrence of femoroacetabular impingement (FAI) appear to be highly prevalent in the asymptomatic population. It remains unclear, however, how these incidental findings should be interpreted clinically and which other variables might differentiate between true incidental findings and preclinical patients. PURPOSE: To study the association between cam and overall hip morphological characteristics and range of motion in impingement patients, asymptomatic patients (healthy patients with radiographic features specific to FAI), and healthy controls. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Morphological parameters describing cam and overall hip anatomy were obtained from 30 patients (10 per subgroup) with use of 3-dimensional computational methods. In addition, the range of internal rotation in high flexion activities was evaluated, and its relation to hip morphological variables was analyzed in a multivariate regression model. RESULTS: Size of the cam lesion and range of motion significantly differed between groups (P < .05). The range of internal rotation on impingement testing was found to average 27.9° in the healthy control group compared with 21.1° in the asymptomatic control group with radiographic features specific to FAI (P < .001) and 12.3° in the patient group (P < .001). Cam size, acetabular coverage, and femoral version appeared to be predictive variables for the range of internal rotation. Seventy-five percent of variance between patients could be attributed to the combined effect of these 3 variables (R = .86). The range of motion was decreased in cam patients and asymptomatic patients, and early femoroacetabular conflict was not restricted to the area of the cam lesion but involved the entire anterior femoral head-neck junction. CONCLUSION: Decreased range of motion, as found in FAI, is not solely dependent on the size or even the occurrence of a cam lesion but should be interpreted by taking into account the overall hip anatomy, specifically femoral version and acetabular coverage. Decreased femoral anteversion and increased acetabular coverage add to the risk of early femoroacetabular collision during sports and activities of daily living and therefore appear to be additional predictive variables, besides the finding of a cam lesion, for the risk of clinical hip impingement development. In addition, the findings suggest that surgical osteochondroplasty to restore a normal range of motion may necessitate more excessive bone resection than what simply appears to be a bump on imaging.
Asunto(s)
Pinzamiento Femoroacetabular/fisiopatología , Cadera/anatomía & histología , Cadera/fisiopatología , Rango del Movimiento Articular/fisiología , Actividades Cotidianas , Adolescente , Adulto , Estudios Transversales , Pinzamiento Femoroacetabular/diagnóstico por imagen , Cabeza Femoral/anatomía & histología , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/fisiopatología , Cadera/diagnóstico por imagen , Humanos , Imagenología Tridimensional/métodos , Masculino , Deportes/fisiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: The description of femoral head sphericity and related risk for femoroacetabularimpingement is currently limited to an angular estimate-the alpha angle-whose relevance and accuracy have been challenged. We developed a three-dimensional approach for both automated digital measurement of the alpha angle and the detection of camdeformities. Accuracy and diagnostic relevance of the alpha angle estimated by means of the oblique axial and multiple radial plane protocol were compared with the computed results. MATERIALS AND METHODS: Using subject-specific statistical information of the femur head and mid-neck region, a method was developed to accurately compute the maximum alpha angle and to define aspherical eccentric areas at the femoral head-neck junction. The method was evaluated on 102 dry cadaver femur specimens. RESULTS: Average detection limit for bony prominences at the head-neck transition was 0.98 mm. Pixel size of the investigated CT data was 0.79 mm. Mean maximum computed alpha angle of the femurs with cam-type morphology as identified by the morphological method was 67.72° (range 53.04-88.02°). Mean maximum computed alpha angle of the femurs without cam deformity was 47.65° (range 38.67-59.81°). Alpha angle estimates obtained by means of the multiple radial plane protocol correlated better (R = 0.88) and showed higher diagnostic agreement (phi = 0.77) with the 3D computational analysis compared to the oblique axial protocol (R = 0.60; phi = 0.67). CONCLUSIONS: The alpha angle seems to be a relevant screening tool when obtained by 3D computed analysis or when estimated according to the multiple radial plane protocol. Estimates obtained by means of the oblique axial protocol have insufficient diagnostic and measurement accuracy.