RESUMEN
Mycobacterium haemophilum has recently been recognized as a newly emerging cause of osteomyelitis in immunocompromised patients. While still uncommon, its incidence has increased significantly with the growing AIDS epidemic. Like its relative M. tuberculosis and M. intracellulare, this organism is acid-fast positive; yet unlike its more well-known counterparts, M. haemophilum requires iron-supplemented culture media and low incubation temperatures (30-32 degrees C) for growth. We describe a case of M. haemophilum osteomyelities in the distal femur of a 36-year-old HIV-positive male, who also presented with multiple skin ulcerations. In an AIDS patient with a lytic bone lesion and concomitant skin eruptions, the diagnosis of M. haemophilum should be entertained so that special culture media can be used and appropriate treatment administered.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Imagen por Resonancia Magnética , Infecciones por Mycobacterium/diagnóstico , Mycobacterium haemophilum , Osteomielitis/diagnóstico , Úlcera Cutánea/diagnóstico , Adulto , Técnicas Bacteriológicas , Medios de Cultivo , Diagnóstico Diferencial , Fémur/patología , Humanos , MasculinoRESUMEN
OBJECTIVE: This study was designed to compare MR imaging findings from T2-weighted fast spin-echo images with and without fat suppression and then to compare surgical results with those MR imaging interpretations in the evaluation of rotator cuff disease. SUBJECTS AND METHODS: T2-weighted fast spin-echo images--with and without fat suppression--of 177 shoulder MR imaging studies were reviewed separately in a retrospective, randomized, and blinded fashion. Both sets of images were read in conjunction with the corresponding proton density-weighted images. The diagnosis of normal tendon, tendinosis, degeneration, and partial- and full-thickness tears was made using established criteria. RESULTS: T2-weighted fast spin-echo techniques with and without fat suppression showed excellent agreement in the diagnosis of normal tendon (kappa=.90) amd full-thickness tears (kappa=.98), good agreement for partial tears (kappa=.70) and moderate agreement for the combined group of tendinosis and degeneration (kappa=.53). MR imaging and surgical correlation in 43 patients showed 86% specificity (95% confidence interval, 65-96%) for intact tendons, and 100% sensitivity (95% confidence interval, 82-100%) for full-thickness tears on T2-weighted fast spin-echo imaging--both without and with fat suppression. For partial tears, MR imaging showed a sensitivity of 92% (95% confidence interval, 65-99%) with fat suppression and 67% (95% confidence interval, 39-86%) without fat suppression. CONCLUSION: T2-weighted fast spin-echo imaging--with or without fat suppression--is a highly sensitive technique in the diagnosis of normal tendons and complete tears of the rotator cuff. Because of increased lesion conspicuity, fat suppression tends to perform better in the diagnosis of partial tears.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Manguito de los Rotadores/patología , Intervalos de Confianza , Humanos , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/estadística & datos numéricos , Estudios Retrospectivos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores , Sensibilidad y EspecificidadRESUMEN
The trapeziometacarpal joint is particularly prone to osteoarthritis due to the great amount of stress applied with everyday activities with the hands. In this essay, radiologic assessment and staging of "basal joint" osteoarthritis, treatments based on radiologic staging and intraoperative findings, and surgical complications are described.
Asunto(s)
Osteoartritis/diagnóstico por imagen , Pulgar/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Humanos , Osteoartritis/cirugía , Osteoartritis/terapia , RadiografíaRESUMEN
Previously developed criteria of normal distal radioulnar joint (DRUJ) axial geometry were applied to routine magnetic resonance (MR) images of 50 wrists. All wrists lacked clinically evident DRUJ instability. An attempt to apply the three geometric criteria to seven of the cases was not possible, since the prescribed landmarks were not visible. The remaining 43 cases were retrospectively divided into a symptomatic group (25 wrists), with clinical abnormalities referable to the ulnar side of the wrist, and an asymptomatic group (18 wrists), with no such abnormalities. Abnormal DRUJ geometry was found in 12 symptomatic and 2 asymptomatic wrists. This difference between the groups is significant (p = 0.02), suggesting that many symptomatic wrists exhibit different DRUJ geometry than is found in most asymptomatic wrists.
Asunto(s)
Imagen por Resonancia Magnética , Radio (Anatomía)/patología , Cúbito/patología , Articulación de la Muñeca/patología , Adolescente , Adulto , Anciano , Huesos del Carpo/lesiones , Femenino , Fracturas Óseas/diagnóstico , Humanos , Artropatías/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Ligamentos Articulares/lesiones , Masculino , Persona de Mediana Edad , Pronación , Estudios Retrospectivos , Supinación , Quiste Sinovial/diagnóstico , Tendones/patologíaRESUMEN
An athletic patient presented with a nontraumatic peroneal neuropathy that failed to resolve after a period of rest. A magnetic resonance image (MRI) showed a multilobulated mass in the course of the common peroneal nerve consistent with a plexiform neurofibroma. Surgical exploration revealed a mass, which coursed from the midthigh to the fibular neck, that was intimately involved with the fibers of the nerve bundle and had cystic degeneration with vesicles along its length. The authors recommend MRI as highly accurate in diagnosing unusual causes of peroneal neuropathy.
Asunto(s)
Neurofibroma Plexiforme/diagnóstico , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Nervio Peroneo , Carrera , Adulto , Electromiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Neurofibroma Plexiforme/fisiopatología , Neurofibroma Plexiforme/cirugía , Neoplasias del Sistema Nervioso Periférico/fisiopatología , Neoplasias del Sistema Nervioso Periférico/cirugía , Nervio Peroneo/patología , Nervio Peroneo/fisiopatología , Nervio Peroneo/cirugíaRESUMEN
OBJECTIVE: We performed a study to determine if unenhanced spin-echo MR imaging can be used to differentiate effusion from synovitis of the knee joint. MATERIALS AND METHODS: Unenhanced spin-echo MR imaging examinations of 1051 consecutive patients referred for evaluation of internal derangement of the knees were reviewed. Twelve of 550 knees with significant joint effusion also had thickened or irregular synovium. Of these, the cause of synovitis was proved in 10 patients. In the other two, the cause was unknown. RESULTS: Thickened synovium was of intermediate signal intensity on T1-weighted MR images compared with the lower signal intensity of joint effusion. In eight cases, the thickened synovium had an intermediate signal intensity on T2-weighted images relative to the high signal of the joint effusion. MR images in the other four cases showed increased signal intensity indistinguishable from that of joint effusion. CONCLUSION: Our experience suggests that unenhanced spin-echo MR images can be used to distinguish synovitis from effusion in the knee joint.
Asunto(s)
Artropatías/diagnóstico , Articulación de la Rodilla , Imagen por Resonancia Magnética , Líquido Sinovial , Sinovitis/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. In 3 of these cases, the grafts appeared thicker in the coronal plane. All cases, including the two clinically unstable knees, showed no break in graft continuity. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Trasplante Óseo , Imagen por Resonancia Magnética , Tendones/trasplante , Adolescente , Adulto , Ligamento Cruzado Anterior/patología , Lesiones del Ligamento Cruzado Anterior , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugíaRESUMEN
A bucket-handle tear of the meniscus is a vertical or oblique tear with longitudinal extension toward the anterior horn in which the inner fragment is frequently displaced toward the intercondylar notch with resultant mechanical locking of the knee joint. A precise MR diagnosis requires identification of the centrally displaced fragment because the peripheral nondisplaced component may have only a subtle truncated or foreshortened appearance that may escape detection. Eighteen consecutive cases of displaced bucket-handle tears of the medial meniscus diagnosed by MR had a characteristic low-signal band extending across the joint and projecting over the medial tibial eminence. The posterior portion was parallel and beneath the posterior cruciate ligament on both sagittal and coronal images. Arthroscopy confirmed the presence and location of the displaced fragment in all 18 cases. Awareness of this characteristic MR finding may increase the sensitivity of MR imaging in the diagnosis of bucket-handle tears of the medial meniscus.
Asunto(s)
Articulación de la Rodilla , Imagen por Resonancia Magnética , Lesiones de Menisco Tibial , Adolescente , Lesiones del Ligamento Cruzado Anterior , Artroscopía , Humanos , Masculino , Meniscos Tibiales/patología , Rotura , Sensibilidad y EspecificidadRESUMEN
Magnetic resonance imaging of 24 symptomatic lower limb amputations revealed that postamputation neuromas were easily diagnosed in above-the-knee amputees. Visualization of nerve trunks in below-the-knee amputees was difficult due to greater compactness of calf muscles. Neuromas on magnetic resonance imaging appeared ovoid or rounded and were usually heterogenous and isointense with muscle. Magnetic resonance imaging also showed additional causes of stump pain such as scar formation, fat in atrophied muscles, soft tissue abscesses, osteomyelitis, and hematomas.
Asunto(s)
Muñones de Amputación , Imagen por Resonancia Magnética , Neuroma/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pierna/inervación , Masculino , Persona de Mediana Edad , Neuroma/etiología , Nervio Ciático/patologíaRESUMEN
This study was undertaken to evaluate the efficacy of magnetic resonance imaging in (1) improving preoperative identification of soft tissue ganglia and in (2) enhancing management by defining their origins, attachments, and extensions. Magnetic resonance images of 17 ganglia were evaluated for intrinsic signal, internal structure, overall shape, and relationship to joints and tendon sheaths using a Philips 0.5 Tesla superconductive magnet with receiver dedicated surface coils. Magnetic resonance imaging proved particularly well suited to delineating soft tissue ganglia and characterizing several of their distinctive diagnostic features which are not optimally imaged by other modalities such as computed tomography and ultrasound.
Asunto(s)
Rodilla , Imagen por Resonancia Magnética , Quiste Sinovial/diagnóstico , Muñeca , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Computed tomographic (CT) analysis of 21 clinically suspected ankle tendon injuries was performed in 18 patients. In six of the 21 ankles surgical exploration was done, and in one ankle evaluation was done while the patient was under anesthesia. In all seven cases the CT findings were confirmed and in three the clinical diagnosis was disproved. CT provided additional information and helped guide treatment in the majority of patients studied. Thus CT is an accurate, noninvasive modality for assessing ankle tendon injuries.
Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Tendones/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos del Tobillo , Niño , Femenino , Pie/inervación , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Radiografía , Rotura , Traumatismos de los Tendones/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagenRESUMEN
CT double-contrast arthrograms were performed on 54 shoulders in 53 patients with recurrent dislocation or subluxation to detect responsible underlying bony or soft-tissue abnormalities. Lesions of the anterior labrum in 52 (96%) of 54 cases and of the capsuloligamentous complex in 42 (78%) of 54 cases were the two most common abnormalities. There was no difference in the degree or number of labral lesions between subluxations and dislocations. However, more severe capsular lesions, subscapularis tendon tears, and widened subscapularis bursae were consistently found among patients with dislocations. Subsequent clinical, arthroscopic, and surgical findings showed that the use of CT double-contrast arthrograms resulted in improved definition of the multiple lesions associated with glenohumeral dysfunction.
Asunto(s)
Artrografía , Inestabilidad de la Articulación/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
Nine cases of recurrent postoperative shoulder instability, resulting from failed surgical repair, were studied with double-contrast computed tomography (CT) arthrography. Repeat operations in seven cases showed excellent correlation between CT and surgical anatomic findings. CT arthrography was useful in confirming the direction of instability, particularly of the posterior and multidirectional types. Capsular laxity, subscapularis muscle and tendon abnormalities, and Bankart lesions that were either recurrent or not identified during previous operations were the most common causes of recurrent dislocations. The precise identification of the soft-tissue and bone abnormalities responsible for shoulder instability augmented clinical evaluation and aided preoperative planning.
Asunto(s)
Artrografía/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Luxación del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Recurrencia , Reoperación , Luxación del Hombro/cirugíaRESUMEN
Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). This is directly related to the special geometry of these fractures that have important transverse components. CT, with its transaxial orientation, is the only radiographic technique that directly images the otherwise inaccessible, horizontally oriented tibial plafond, the integrity of which largely determines the prognosis. CT is the method of choice for preoperative and postoperative evaluation of these injuries.
Asunto(s)
Fracturas de la Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Niño , Femenino , Humanos , MasculinoRESUMEN
Injury to the peroneal tendons is one of the major long-term complications of intraarticular calcaneal fractures and heretofore has been difficult to diagnose by noninvasive radiography. Retrospective review of CT scans of 24 intraarticular calcaneal fractures, obtained shortly after injury, identified 22 cases (92%) of acute peroneal tendon abnormalities. In most of these cases, multiple findings were present. These included lateral displacement in 14 (58%) of 24, impingement by bony fragments in eight (33%), subluxation or dislocation in six (25%), soft-tissue masses around the tendons representing hematomas or early scar tissue in five (21%), and entrapment of the tendons in three (13%). In 10 cases with long-term follow-up, impingement on the tendons by bony fragments correlated well with the subsequent development of peroneal tenosynovitis, while hematoma around the tendons or lateral displacement of the tendons was clinically insignificant. Thus, CT in the immediate postfracture period, can be used to detect and categorize acute peroneal tendon injuries as well as possibly to predict the likelihood and nature of subsequent development of peroneal tenosynovitis.
Asunto(s)
Calcáneo/lesiones , Pie , Fracturas Óseas/complicaciones , Traumatismos de los Tendones/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Fracturas Óseas/diagnóstico por imagen , Humanos , Traumatismos de los Tendones/etiologíaRESUMEN
One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb.
Asunto(s)
Muñones de Amputación/complicaciones , Pierna/cirugía , Neuroma/etiología , Neoplasias del Sistema Nervioso Periférico/etiología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pierna/inervación , Masculino , Persona de Mediana Edad , Neuroma/diagnóstico por imagen , Neoplasias del Sistema Nervioso Periférico/diagnóstico por imagenRESUMEN
Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films.
Asunto(s)
Calcáneo/lesiones , Fracturas Óseas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Calcáneo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Computed tomographic (CT) evaluation of the peroneal tendons was obtained in 25 normal ankles and 30 abnormal ankles studied for trauma. The tendons and associated soft-tissue and bony structures, such as the calcaneofibular ligament, superior and inferior peroneal retinacula, fibular groove, and peroneal tubercle, which have heretofore evaded documentation on routine radiographs, are illustrated and discussed. Special attention is given to normal variations such as convex fibular tip and enlarged peroneal tubercle, which predispose the peroneal tendons to abnormal mechanical stresses. Examples of CT-established peroneal tendon abnormalities in the 30 cases examined are also demonstrated. These abnormalities include subluxation, dislocation, entrapment, and tenosynovitis of the peroneal tendons. The authors believe CT has proved to be an extremely useful and relatively noninvasive imaging tool for the evaluation of peroneal tendon injuries.
Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Traumatismos de los Tendones/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Traumatismos del Tobillo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Growth deformities of the distal femur and unusual gait disturbances were observed in four girls who had had neonatal osteomyelitis and septic arthritis. In each case apparent absence or hypoplasia of one of the femoral condyles, as seen on plain radiographs, was associated with marked genu varum or genu valgum. Arthrography showed the apparently missing condyle to be present in a cartilaginous form, with preservation of the articular surfaces. Based on these findings, surgical treatment was limited to corrective osteotomy.
Asunto(s)
Artritis Infecciosa/diagnóstico por imagen , Fémur/anomalías , Osteomielitis/diagnóstico por imagen , Niño , Preescolar , Femenino , Fémur/diagnóstico por imagen , Humanos , Lactante , Radiografía , Infecciones Estafilocócicas/diagnóstico por imagenRESUMEN
The elbow joint was evaluated by means of computed tomography (CT) immediately following double-contrast arthrography. Normal baseline anatomy and representative abnormal studies are illustrated. Intraarticular abnormalities, such as osteocartilaginous bodies, hyperplastic synovium, fracture fragments, and osteophytes, were identified and precisely located on postarthrography CT scans. This technique, which enabled such abnormalities to be seen, has provided an anatomic and mechanical basis for seemingly idiopathic instances of limited elbow motion.