Asunto(s)

RESUMEN

To further evaluate the role of magnetic resonance (MR) imaging in diagnosing and managing muscle injuries, eight patients with muscle pain or palpable masses were imaged. MR findings were correlated with clinical follow-up data. Increased signal was noted on T2-weighted images in torn and overused muscles. One extensively scarred muscle required surgical biopsy to exclude a fibrous tumor. Three partial muscle tears were treated conservatively. One complete musculotendinous junction tear required tendon transfer. MR studies noninvasively identified and staged various muscle injuries, thereby influencing management.

Asunto(s)

RESUMEN

A 53-year-old man known to have osteoarthritis of the left knee was examined because of a soft-tissue swelling overlying the pes anserinus tendon. Plain radiography and computed tomography revealed an expansile subchondral cyst of the proximal tibia. The cyst was multiloculated, had a sclerotic margin and an extraosseous soft-tissue component, and interrupted the cortex. Proof of a degenerative cyst was obtained by open biopsy. Such presentation in the knee is rare. Awareness of the possible aggressive behaviour of such degenerative cysts should help avoid confusion with neoplasm.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) and computed tomography (CT) in the diagnosis of intramuscular ganglia (IMG) that arise from the superior tibiofibular joint (STFJ). MATERIAL AND METHODS: Our series consisted of three men and three women. Four patients were studied by MRI, one by CT only, and two by both modalities. Contrast was used in one of the two patients studied by CT. MRI was obtained in at least two orthogonal planes to demonstrate the relation of the ganglia to STFJ. RESULTS: The MR and CT appearance of these ganglia was basically that of a well-defined soft tissue mass with low attenuation on CT images consistent with the presence of fluid. On MR studies, they had an isointense signal on T1-weighted images and a homogenous high-intensity signal on T2-weighted images. MRI demonstrated the attachment of these ganglia to the STFJ. CONCLUSION: CT and MRI were effective, noninvasive modalities in the evaluation of IMG. The imaging features on both modalities were consistent with the presence of fluid- containing lesions that had close proximity and were attached to the STFJ. The combination of location and the fluid consistency of these lesions facilitated the diagnosis.

Asunto(s)

RESUMEN

The purpose of this study is to evaluate the role of sonography in diagnosing lipohemarthrosis. Sonography was performed on seven patients with intra-articular fractures of the knee, shoulder, and hip. An in vitro mixture of fat and blood was examined as the gold standard. In the patients scanned a few minutes after immobilization, a two-band appearance of joint effusion was present, representing a fat-blood level. One patient scanned 3 hours after immobilization showed a three-band appearance of joint effusion, corresponding to the layers of fat, serum and red blood cells. Results of this study indicate a high reliability of ultrasonography in detecting lipohemarthrosis.

Asunto(s)

RESUMEN

The study presents the ultrasound appearance of the intramuscular ganglia arising from the superior tibio-fibular joint. An oval, anechoic septated mass with distal sound enhancement in the antero-lateral aspect of the leg was seen in five examined patients. In all the cases, ultrasound-guided needle aspiration was performed and viscous fluid characteristic of ganglia was obtained. All the patients were treated by surgical excision of mass. Local recurrence, which occurred in three cases, was confirmed by ultrasound. The study indicates that ultrasound is useful in diagnosing intramuscular ganglia, in planning the treatment, and in the follow-up examination. Ultrasound-guided needle aspiration is a helpful technique in confirming the diagnosis.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVE: The objective was to search for magnetic resonance imaging evidence of medial collateral ligament (MCL) injury in knees with proven tears of the anterior cruciate ligament (ACL) and medial meniscus; the three abnormalities that make up O'Donoghue's triad. Although the MCL injury can be unapparent clinically, knee joint stability may be compromised. DESIGN: The superficial portion of the MCL was evaluated on 19 MR studies of 16 knees with arthroscopically proven ACL and medial meniscal tears. MCL thicknesses were compared to those on MR images of 19 normal knees. PATIENTS: The injured knees were of 13 men and 3 women, ranging in age from 19 to 56 years; the normal knees were of 10 men and 9 women, ranging in age from 19 to 55 years. RESULTS AND CONCLUSIONS: The medial collateral ligaments of all injured knees were abnormal, and, as a group, they had greater thicknesses and more intraligamentous thickness variability than normal knees. The MR appearance of both ACL and medial meniscal tears served as indirect evidence of MCL injury, with irregular MCL thickening indicative of prior injury.

Asunto(s)

RESUMEN

A 62-year-old man who had had chronic brucellosis for at least 14 years, presumably caused by ingestion of unpasteurized milk, presented with recurrent, multifocal osteomyelitis involving both tibias and a humerus, which had a pathologic fracture. Radiographs showed a large destructive lesion in the humeral diaphysis with a pathologic fracture and multiloculated radiolucencies, together with sclerotic zones in multiple long bones. Histologically, necrotizing, granulomatous inflammatory changes were compatible with a diagnosis of osteomyelitis. Bone biopsy cultures and agglutination titers were positive for Brucella abortus. The case represents an uncommon manifestation of Brucella infection which is particularly rare in the United States. A proper clinical examination should lead to consideration of the diagnosis.

Asunto(s)

RESUMEN

Magnetic resonance (MR) studies were performed on 30 consecutive patients who continued to be symptomatic despite negative or inconclusive findings on radiographs and other imaging studies including radionuclide bone scans, computed tomography, and/or polytomography. There were 9 men and 21 women, 20-92 years old (mean age 63 years) whose MR studies were done 3-72 h after frank trauma in 22 cases and in another 8 after 1-4 weeks of increasing pain subsequently attributed to trauma or unaccustomed effort. MR studies were performed using 0.5-T (Phillips) or 1.5-T (Phillips, GE) superconductive magnets. Results indicated that: (1) MR images allowed identification of acute fractures in an emergency room setting, as well as subtle subacute or chronic fractures in the context of strong clinical suspicions despite negative or inconclusive radiographs and other subsequently indecisive imaging studies. (2) MR imaging is the most sensitive way of documenting the earliest changes in traumatized osseous and soft tissue structures simultaneously.

Asunto(s)

RESUMEN

Owing to the exceptional mechanical precariousness of the glenohumeral joint, dislocations and instabilities are common. Because posterior dislocation or instability of the joint occurs infrequently, these abnormalities may be misdiagnosed on routine radiographic examinations in acute shoulder injuries. We present five patients in whom sonographic examination was used to diagnose posterior shoulder instability (three cases) and posterior shoulder dislocation (two cases). The sonographic technique demonstrates the presence of instability or dislocation and permits dynamic examination of the shoulder joint. Ultrasonography emerges as a useful and efficient novel technique for detecting these disorders. The accuracy, sensitivity, and specificity of the technique presented here are currently being determined.

Asunto(s)

RESUMEN

OBJECTIVE: The purpose of the study was to evaluate the role of sonography in diagnosing traumatic tears of the quadriceps tendon. More specifically, it was intended to determine the value of sonography in differentiating complete from partial tears and thus in directing therapy. Knees of asymptomatic volunteers and patients' contralateral knees were used as normal standards. SUBJECTS AND METHODS: Sonography was performed in 29 patients with injuries of the quadriceps tendon in a 3-year period. As the control, 59 normal knees were examined: both knees of 15 healthy subjects and 29 contralateral knees of the injured patients. In all cases, longitudinal and transverse sonograms were obtained. In five cases (four complete and one partial rupture), the sonographic diagnosis was confirmed surgically. Those remaining patients who had a partial tendon tear were treated conservatively. Follow-up sonograms were obtained in 10 cases (three treated with surgery and seven not) and showed integrity of the affected tendon. RESULTS: Among the 29 patients, sonograms showed a partial rupture (focal hypoechoic defect in the tendon) in eight and a complete rupture (complete disruption of the tendon fibers) in four. In the remaining 17 cases, the tendon was intact. The high sensitivity and specificity of sonography (100% or four of four in our sample) in the diagnosis of complete tears of the quadriceps tendon were confirmed by surgery. As only one partial tear was confirmed by surgery (the remaining seven were treated conservatively), the sensitivity and specificity of sonography with respect to partial tears could not be determined. CONCLUSION: Results of this study, albeit obtained from a limited sample, indicate that sonography offers a high degree of sensitivity and specificity in the evaluation of quadriceps tendon rupture. This noninvasive and easily available imaging technique should be considered in the diagnostic workup and treatment planning of patients with suspected tears of the quadriceps tendon.

Asunto(s)

RESUMEN

This study was performed to assess the effectiveness of ultrasonography in the diagnosis of wrist ganglia and in their differentiation from other lesions. Sonographic examination of 73 patients with palpable masses was performed; their healthy hands and those of 25 healthy volunteers constituted the reference standard. Ganglia appeared sonographically as anechoic oval, round, or lobulated cystic structures. Ultrasound proved an accurate tool in their diagnosis, with the general advantages of easy, quick, and inexpensive application.

Asunto(s)

RESUMEN

The early manifestations of sickle cell crisis in soft tissues are important to recognize, though rarely manifest on radiographs and difficult to evaluate on computed tomography and bone scans. Documentation is critical, however, if appropriate judgments as to emergency treatment versus conservative measures are to be made. Seventeen adults seen in the emergency room or hospitalized in presumed sickle cells crisis underwent magnetic resonance imaging within 24-72 h of presentation. Results indicate that magnetic resonance imaging is a sensitive modality for documenting early soft tissue pathology which may be the predominant or sole cause of sickle cell crisis.

Asunto(s)

Asunto(s)

RESUMEN

A retrospective sonographic study of soft tissue masses of the hand was undertaken. A spherical fluid-filled structure with a well-defined wall was seen in 13 patients and the cases were diagnosed as ganglia. This diagnosis had been generally suspected clinically in the presence of a firm nonpainful lump. This study indicates that ultrasound is a valuable diagnostic tool for the study of soft-tissue masses of the hand and in the differential diagnosis of other soft tissue lesions, such as pigmented villonodular synovitis or tenosynovitis.

Asunto(s)

RESUMEN

Fracture of thumb sesamoids is a rare injury. We are reporting four cases. In two cases, the fracture involved the ulnar sesamoid and in two others, the radial sesamoid. The right thumb was affected in two patients and the left thumb in the other two. In one patient, arthrography of the metacarpophalangeal joint of the thumb demonstrated contrast leakage from the volar aspect of the joint and confirmed volar plate rupture. All patients were treated conservatively with immobilization. Normal hand function was restored in all four patients. Sesamoid fractures may accompany severe injuries of the fibrous plate. Radiologists and orthopaedists should be aware of the possibility of this fracture in injuries of the thumb. Early recognition of the fracture leads to appropriate treatment and avoids possible instability of the metacarpophalangeal joint.

Asunto(s)

RESUMEN

A tumor initially presenting as a round cell sarcoma in the proximal tibia of a 42-yr-old male disseminated to involve the femur, multiple tarsal bones, and the lungs. In addition to round cell areas resembling lymphoma, other areas of the tumor produced osteoid matrix and still other areas suggested epithelial differentiation. Immunohistochemical staining revealed the presence of epithelial markers in areas of epithelial differentiation, leukocyte markers in areas of lymphomatous differentiation, and neither marker in areas of osteosarcomatous differentiation. The finding of epithelial elements in a primary bone tumor is rare, and this report is one of the first confirming their presence using immunohistochemical markers. The findings are consonant for neither epithelial nor lymphoid neoplasms and in all probability represent multipotential differentiation in a primitive mesenchymal tumor.

Asunto(s)

Asunto(s)

Asunto(s)