Radiological evaluation of patellofemoral instability and possible causes of assessment errors

Patellofemoral instability (PI) is the disruption of the patella's relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications

Proximal tibiofibular joint arthrodesis due to recurrent giant ganglion cyst causing peroneal nerve palsy

Ganglion cysts are masses that we encounter frequently in our daily practice, usually in the upper extremity, less frequently in the lower extremities, and rarely cause compression symptoms. We present a case of a massive ganglion cyst of the lower limb causing peroneal nerve compression, managed with excision and proximal tibiofibular joint arthrodesis to prevent recurrence.Examination and radiological imaging of a 45-year-old female patient who was admitted to our clinic showed new-onset weakness in right foot movements and numbness on the dorsum of the foot and lateral cruris, a mass consistent with a ganglion cyst expanding the muscle was detected in the peroneus longus muscle. In the first surgery, the cyst was carefully resected. After three months, the patient came with a repeated mass on the lateral side of the knee. After confirmation of the ganglion cyst with clinical examination and MRI, a second surgery was planned for the patient. In this stage, we performed a proximal tibiofibular arthrodesis for the patient. Her symptoms recovered during the early follow-up period and no recurrence occurred during the two years of the follow-up period.Although the treatment of ganglion cysts seems easy, it can sometimes be challenging. We think that arthrodesis may be a good treatment option in recurrent cases

Re-evaluation of the symptoms of Hirayama disease through anatomical perspective

Hirayama disease is a rare disease of the anterior horn motor neuron caused by compression of the cervical spinal cord when the neck is flexed. Cervical myelopathy may accompany the disease. It is characterized by symmetrical or asymmetrical muscle weakness and atrophy of muscles innervated by lower cervical and upper thoracic motor neurons. We recorded two male cases of Hirayama disease between the ages of 15 and 21 based on magnetic resonance imaging (MRI) features obtained from the cervical neutral state and from the flexion position which appeared in the right upper extremity. Loss of strength and atrophy in the right upper extremities was existent in clinical findings of these patients. When MRI was taken in the flexion position, there were dilated veins as hypointense signal void on T2 weighted series in posterior epidural area. The contrast enhancement was seen on these veins. It was observed that the posterior dura was displaced anteriorly and the anterior subarachnoid space was narrow. In cases which show clinical findings such as atrophy and loss of strength, having normal MRI results obtained in the neutral position makes it difficult to diagnose Hirayama Disease. In case of a suspicion of Hirayama disease the diagnosis can be made more easily by MRI taken in the flexion position. These case reports aim to bring Hirayama disease to mind and optimize the management of affected individuals

Evaluating the features of interdigital neuroma using 3-Tesla magnetic resonance imaging

Interdigital neuroma is an entrapment neurop-athy of the interdigital nerve. Previously, studies on interdigital neuroma were done with 1 Tesla Magnetic Resonance Imaging and more often 1.5 Tesla Magnetic Resonance Imaging. We used 3 Tesla Magnetic Resonance Imaging in our study and we did not encounter as much as we know about the study with 3 Tesla Magnetic Resonance Imaging in the literature. Between 2013 and 2019, the 3 Tesla Magnetic Resonance Imaging results of 39 consecutive surgically-confirmed interdigi- tal neuromas and patients' files were retrospec- tively evaluated. The soft tissue surrounding the prominent interdigital nerve "target sign" were assessed. Spearman's rho, Pearson's correlation tests, and Mann-Whitney U-tests were used. Of the 39 cases (mean transverse dimension = 4.64 mm), 35 (89.7%) were hypointense on T1-weight - ed sequencing, 34 were intermediate (87.1%) on short tau inversion recovery sequencing, and 29 (74.3%) had slightly-moderately enhanced neuro-mas on post-contrast spectral presaturation with inversion recovery sequences. A statistically sig-nificant negative relationship was found between contrast enhancement and disease duration (p = 0.020). On short tau inversion recovery or spec-tral presaturation with inversion recovery series, the intralesional nerve view "target sign" was ob-served in 23 (58.98 %) of 39 neuromas. This is the first study in the literature with 3 Tesla Magnetic Resonance Imaging that shows the visual charac-teristics of interdigital neuroma and its possible contribution to the diagnosis of the disease

Mezenterik Kistik Lenfanjiom: BT Bulguları

Abdominal lenfanjiomlar oldukça seyrek görülen kistik lezyonlar olup en sık ince barsak mezenterinde yerleşim gösterir. Asemptomatik olabileceği gibi akut ya da kronik karın ağrısı ve distansiyon gibi nonspesifik semptomlar görülebilir. Ultrasonografi ile lezyonun kistik karakteri belirlenebilmekle beraber kompleks anatomik ilişkilerinin saptanabilmesi için BT ve MRG gereklidir. Çalışmamızda çok kesitli BT incelemesinde insidental olarak saptanan, ince barsak mezenterinde lokalize kistik lenfanjiom olgusunun bulguları sunulmuştur

Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?

WOS: 000371172200007PubMed ID: 26034194Background: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction

A rare congenital liver anomaly: Hypoplasia of left hepatic lobe

WOS: 000388621700033PubMed ID: 28179708Morphologic anomalies of liver, as opposed tomany other visceral organs, are very rare. Hypoplasia or agenesis of left lobe of the liver is defined as the absence of liver tissue on the left side of liver without previous disease or surgery. It is usually an incidental finding revealed by imaging exams or during abdominal surgery. A 44-year-old female patient was admitted to the hospital for abdominal pain and discomfort. Physical examination revealed no specific abnormality. Routine laboratory tests were normal. Imaging studies showed the absence of the left hepatic lobe. She had no history of surgery, trauma or liver disease and was diagnosed as having congenital hypoplasia of left hepatic lobe. Anomalies of hepatic morphology are due to developmental defects during embryogenesis and are rarely seen. They are generally diagnosed incidentally based on imaging techniques. Early diagnosis of such an anatomical anomaly is necessary for surgical planning, for appropriate evaluation of intraoperative surgical findings, and for the design of the postoperative approach to therapy

An unusual long-term survey of a patient with widespread malignant urachal tumor, not given chemotherapy or radiotherapy

The urachus establishes a connection between the dome of the bladder and the umbilicus throughout fetal life. If the urachus does not close completely, malignancy is a potential complication. The primary treatment for malignant urachal tumor is surgical excision. A 61-year-old male patient diagnosed with urachal carcinoma had undergone partial cystectomy 25 years previously. Twenty years later, local recurrence was treated with another partial cystectomy without umbilical remnant excision. Recurrence at the umbilical site was excised 2 years later, but intraperitoneal invasion had occurred, and the patient underwent a total colectomy at that time. Local disease and disseminated metastases in the thorax and intra- and extraperitoneal areas were noted upon admission to our hospital. Urachal carcinomas are usually aggressive tumors, and surgical treatment should include partial or radical cystectomy and excision of the urachus and umbilicus, to prevent local recurrence and distant metastasis

Scimitar syndrome associated with gallbladder duplication

WOS: 000335276400027PubMed ID: 24560746Scimitar syndrome is a rare congenital anomaly associated with the venous drainage of the lung to the inferior vena cava through a systemic vein. Chest radiography of an asymptomatic patient, aged 36, showed a linear opacity extending from the pulmonary hilum to the diaphragm, on the right chest (Scimitar sign). Computerized tomography of the thorax exposed that the cause of that image was Scimitar vein. Abdominal ultrasonography revealed duplication in the gallbladder. The literature holds no reports of an association between Scimitar syndrome and gallbladder duplication. Secondary gastrointestinal malformations can also be found in patients suffering from this syndrome. (C) 2014 Elsevier Inc. All rights reserved

Postpartum stress fracture of bilateral tibia: A case report

Stress fractures are overuse injuries of the bone characterized by a magnetic resonance imaging (MRI) finding of the fracture line with bone marrow edema. Clinical findings are tenderness and persistent pain. It is usually related to repetitive stresses. A 25-year-old woman was admitted with bilateral severe knee pain. She was in the postpartum period and the complaints started three days after the beginning of 2-h daily walk. The initial plain radiograph showed no abnormality, while MRI demonstrated bilateral incomplete fracture line at the proximal tibia. The patient had accompanying vitamin D deficiency and osteopenia, diagnosed with pregnancy-related osteopenia and stress fracture of bilateral proximal tibia. We advised cessation of weight bearing, resting, and supplementation of calcium and vitamin D. This report highlights that, in the postpartum period, persistent pain may indicate bone lesions such as stress fractures, particularly developing shortly after a vigorous physical activity. Detailed physical examination and further investigations are necessary to detect these fractures and risk factors