Air in Parameniscal Cyst: Alarming Appearance of a Benign Condition

Background: Parameniscal cysts are an uncommon finding in radiology and often are associated with meniscal tears. While they do not always present with symptomology, if they do they may manifest with knee pain and require radiologic studies. We present an unusual case of a parameniscal cyst which appeared remarkably similar to necrotizing fasciitis. Case Report: A 60 year old male patient with a history of gout and previous gout exacerbations presented to the emergency department with knee pain. Despite the lack of systemic symptoms, his clinical picture in conjunction with the radiological finding of subcutaneous air made him suspicious for necrotizing fasciitis. Upon further imaging, it was concluded that the patient had a parameniscal cyst. Conclusion: This case is unique because it takes a relatively benign finding and differentiates it from something much more severe. This is the only case we know which this similarity exists.https://scholarlycommons.henryford.com/merf2019caserpt/1118/thumbnail.jp

Peripheral polyneuropathy associated with COVID-19 in two patients: A musculoskeletal ultrasound case report

As coronavirus disease 2019 (COVID-19) spreads, we are encountering multiple different symptoms and related complications. Although the vast majority of literature is focused on its pulmonary manifestations, recent reports have mentioned neurologic manifestations but typically those related to the central nervous system and diagnosed utilizing magnetic resonance imaging. We present two cases of COVID-19-associated peripheral polyneuropathy diagnosed utilizing musculoskeletal ultrasound (US), which to our knowledge is the first such case report. US is an instrumental portable modality that can be used for COVID-19 patients in isolation. As this virus continues to spread, understanding and recognizing these COVID-19 related complications and their sonographic findings are crucial

Acute patellar tendon ruptures: The diagnostic utility of sonography for tear detection and characterization in the emergent setting

Purpose To determine the accuracy of ultrasound for diagnosing and characterizing acute patellar tendon ruptures, as well as to investigate secondary sonographic signs that may aide in identifying tear location, using surgical findings as the reference standard. Methods The sonographic findings of 46 consecutive knee ultrasounds obtained for clinically-suspected extensor mechanism injury (23 cases reporting a torn patellar tendon and 23 cases reporting an intact patellar tendon) were compared with intra-operative findings in those patients who underwent patellar tendon surgery. Twomusculoskeletal radiologists blindly and retrospectively reviewed all 46 cases to indicate the presence or absence of a patellar tendon tear, to identify suspected tear location, and to comment on refraction artifact and peritendinous fluid, which were also correlated with intraoperative findings. Results The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for diagnosing patellar tendon rupture were 100%. Further, ultrasound correctly identified tear location in 94% of surgically-proven cases. The presence of refraction artifact (P \u3c 0.05) and increasing amount of peritendinous fluid (P \u3c 0.05) were associated with higher likelihood of tear. Relying solely on refraction artifact to identify tear location proved less accurate (P \u3c 0.05, P = 0.08) than using all sonographic signs available. There was no difference in tear location accuracy with varying amount of peritendinous fluid (P \u3e 0.24) or conspicuity of refraction artifact (P = 1.0). Conclusions Ultrasound is highly accurate for diagnosing and characterizing acute patellar tendon ruptures. Because acute repair is preferred in order to avoid long-term morbidity, and missed clinical diagnosis reportedly ranges from 10-50%, we advocate for an increasing role of ultrasound in the emergency setting to rapidly and effectively evaluate the integrity of the patellar tendo

Acute patellar tendon ruptures: The diagnostic utility of sonography for tear detection and characterization in the emergent setting.

Purpose To determine the accuracy of ultrasound for diagnosing and characterizing acute patellar tendon ruptures, as well as to investigate secondary sonographic signs that may aide in identifying tear location, using surgical findings as the reference standard. Methods The sonographic findings of 46 consecutive knee ultrasounds obtained for clinically-suspected extensor mechanism injury (23 cases reporting a torn patellar tendon and 23 cases reporting an intact patellar tendon) were compared with intra-operative findings in those patients who underwent patellar tendon surgery. Twomusculoskeletal radiologists blindly and retrospectively reviewed all 46 cases to indicate the presence or absence of a patellar tendon tear, to identify suspected tear location, and to comment on refraction artifact and peritendinous fluid, which were also correlated with intraoperative findings. Results The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for diagnosing patellar tendon rupture were 100%. Further, ultrasound correctly identified tear location in 94% of surgically-proven cases. The presence of refraction artifact (P \u3c 0.05) and increasing amount of peritendinous fluid (P \u3c 0.05) were associated with higher likelihood of tear. Relying solely on refraction artifact to identify tear location proved less accurate (P \u3c 0.05, P = 0.08) than using all sonographic signs available. There was no difference in tear location accuracy with varying amount of peritendinous fluid (P \u3e 0.24) or conspicuity of refraction artifact (P = 1.0). Conclusions Ultrasound is highly accurate for diagnosing and characterizing acute patellar tendon ruptures. Because acute repair is preferred in order to avoid long-term morbidity, and missed clinical diagnosis reportedly ranges from 10-50%, we advocate for an increasing role of ultrasound in the emergency setting to rapidly and effectively evaluate the integrity of the patellar tendon