Imaging of Benign Soft Tissue Tumors

The evaluation of soft tissue tumors should be approached systematically, with careful assessment of the patient\u27s age, clinical presentation, anatomical location of the mass, and MRI characteristics. The imaging evaluation of a suspected soft tissue mass begins with conventional radiography to exclude an underlying osseous lesion and assess for any lesional calcification. MRI is particularly useful in evaluating the signal intensity, enhancement pattern, and extent of soft tissue masses that can expand beyond fascial planes and involve the neurovascular bundle, joint, or bone. Among the common benign soft tissue tumors, a fairly definitive imaging diagnosis can be made in cases of lipoma, elastofibroma dorsi, hemangiomas, myositis ossificans, giant cell tumor of tendon sheath, and peripheral nerve sheath tumors. In the remaining cases, the differential diagnosis can be narrowed by knowing the patient\u27s demographics and any associated syndromes, in conjunction with recognizing specific MRI features. Knowledge of the World Health Organization\u27s tumor designations and the incidence of specific tumors based on patient age and anatomical location are vital tools for the interpreting radiologist

Imaging of Ankle Replacements

Significant innovations in the field of total ankle replacement surgery have occurred since the early disappointing experiences with first-generation devices. In recent years, total ankle arthroplasties are commonly placed in patients with end-stage ankle osteoarthrosis, supplanting ankle arthrodesis as the procedure of choice at some institutions. Careful clinical and preoperative radiographic evaluation is helpful to plan concomitant ligament release, ligament reconstruction, or osteotomy. Careful attention to radiographic signs of early hardware loosening or subsidence can prompt intervention while bone loss is still minimal, and computed tomography has an adjunct role in the evaluation of periprosthetic lucency and osteolysis

Klippel–Feil Syndrome with Sprengel Deformity and Extensive Upper Extremity Deformity: A Case Report and Literature Review

Introduction: Klippel–Feil syndrome (KFS) is a congenital anomaly resulting from fusion of cervical vertebral bodies secondary to the dysregulation of signaling pathways during somite development. It is commonly associated with scoliosis and Sprengel deformity. We present a case of KFS with commonly associated abnormalities as well as deformities that have not yet been reported in the literature. Case Presentation A 3-year-old girl presented for further evaluation of a left upper extremity deformity following a negative genetic workup. Upon physical exam and radiographic imaging, the patient was diagnosed with KFS and associated abnormalities including cervical scoliosis, Sprengel deformity, and congenital deformity of the left upper extremity. Deformities of the left upper extremity include radioulnar synostosis, a four-rayed hand, and absent thenar musculature. The Sprengel deformity was corrected surgically with a Woodward procedure. Discussion Congenital musculoskeletal deformities can be differentiated based upon spinal and limb embryology. The presence of extraspinal abnormalities not originating from somite differentiation may suggest a severe form of KFS. Important considerations in the workup of the KFS patient include looking for deformities of the shoulder girdle and upper extremities to identify abnormalities for intervention at a young age

Magnetic Resonance Imaging Of Hip Tumors

After initial evaluation with radiography, magnetic resonance (MR) imaging is the most common modality used to establish the diagnosis and characterize osseous and soft tissue tumors of the hip. Tumors involving the proximal femur are often benign, and MR imaging can be specific in diagnosing solitary bone cyst, osteochondroma, and chondroblastoma. Benign and malignant soft tissue tumors about the hip are often nonspecific in their MR imaging appearances, but knowledge of the patient\u27s age may direct a more limited differential diagnosis. In the setting of malignancy, MR imaging is commonly used to stage tumors and follow patients postoperatively. © 2013 Elsevier Inc

Ct And Mr Imaging Of The Postoperative Ankle And Foot

A variety of surgical procedures exist for repair of both traumatic and degenerative osseous and soft-tissue pathologic conditions involving the foot and ankle. It is necessary for the radiologist to be familiar with these surgical procedures, so as to assess structural integrity, evaluate for complicating features, and avoid diagnostic pitfalls. Adequate interpretation of postoperative changes often requires access to surgical documentation to evaluate not only the surgery itself but the expected timeline for resolution of normal postoperative changes versus progressive disease. Appropriate use of surgical language in radiology reports is another important skill set to hone and is instrumental in providing a high-quality report to the referring surgeons. The pathophysiology of a myriad of surgical complaints, beginning from the Achilles tendon and concluding at the plantar plate, are presented, as are their common appearances at computed tomography and magnetic resonance imaging. Commonly encountered entities include Achilles tendon tear, spastic equinus, nonspastic equinus, talar dome osteochondral defect, tarsal tunnel syndrome, plantar fasciitis, pes planovalgus, pes cavovarus, peroneal tendinosis, lateral ligament complex pathology, Morton neuroma, plantar plate tear, and metatarsophalangeal joint instability. Computer-generated three-dimensional models are included with many of the procedures to provide a more global view of the surgical anatomy. Correlation with intraoperative photographs is made when available. When appropriate, discussion of postoperative complications, including entities such as infection and failure of graft integration, is presented, although a comprehensive review of postoperative complications is beyond the scope of this article. Notably absent from the current review are some common foot and ankle procedures including hallux valgus and hammertoe corrections, as these are more often evaluated radiographically than with cross-sectional imaging

Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware