Value of shoulder US compared to MRI in infants with obstetric brachial plexus paralysis

PURPOSEChildren with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability. METHODSForty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4–6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test.RESULTSGlenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028).CONCLUSIONOur results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI

Magnetic Resonance Imaging (Mri) of Snapping Scapula in a 10-Year-Old Boy

Background Snapping scapula syndrome, also known as scapulothoracic crepitus or bursitis, is a manifestation of a mechanical abnormality of the scapulothoracic joint. In addition to characteristic findings on physical examination, magnetic resonance imaging (MRI) exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Case Report We present a case of a 10-year-old boy who had snapping scapula syndrome of the right scapula that was associated with edema of the serratus anterior muscle at the scapulothoracic interface and with scapulothoracic, specifically supraserratus, bursitis on MRI. Conclusions MRI in snapping scapula syndrome, which is a clinical diagnosis, exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Such soft tissue findings of snapping scapula syndrome need to be kept in mind while evaluating routine shoulder and/or scapular region MRI, especially in the absence of relevant clinical information at the time of the imaging study.PubMedScopu

Mri Of Lower Extremity Impingement And Friction Syndromes In Children

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon-lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data.Wo

Trigeminal Nerve And Pathologies In Magnetic Resonance Imaging – A Pictorial Review

PubMe

The role of dermoscopy in the diagnosis of subungual glomus tumors

Background and Objectives The dermoscopic features of glomus tumors have only been described in a few case reports. The aim of this research was to define the clinical and dermoscopic features of subungual glomus tumors. Methods Thirty-two patients with subungual glomus tumors were evaluated retrospectively. Results On the photographs, longitudinal erythronychia, longitudinal leukonychia, punctate leukonychia, splinter hemorrhage, isolated capillaries, distal notching, distal subungual hyperkeratosis, onycholysis, and onychoschizia were found. There was no statistical difference between the rates of detection of these findings by evaluation from clinical photographs alone and from both clinical and dermoscopic photographs. While ramified vessels with bluish spots could be detected in only five of 26 cases with bluish spots in their clinical photographs, these ramified vessels were seen in 14 cases in bluish spots in dermoscopic photographs (P = 0.004). Compared to clinical examination, dermoscopy was able to detect blue spots in three more cases. Lesion duration was higher in the cases with ramified vessels (P = 0.018). Conclusions Dermoscopy seems to contribute to the clinical examination in displaying only ramified vessels located in bluish spots and in determining the localization of the subungual tumors. The presence of ramified vessel in the bluish spots is strongly related to lesion duration

Giant Omental Cyst (Lymphangioma) Mimicking Ascites And Tuberculosis

Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ascites on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ascites and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ascites. We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ascites at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination.PubMedWo

Evaluation of Pre and Postoperative Polysomnographic Data in Patients with Idiopathic Parkinson's Disease Undergoing Deep Brain Stimulation Intended Bilateral Subthalamic Nucleus

Objective: Deep brain stimulation (DBS) intended to bilateral subthalamic nucleus (STN) used in the Parkinson's disease (PD) has been reported to lead improved subjective sleep quality, increased sleep efficiency, decreased wakefulness time after sleep, and increased total sleep time. On this basis, we aimed to evaluate the sleep structure and quality by polysomnographic (PSG) investigation parameters in patients diagnosed with idiopathic PD who were planned to undergo bilateral STN-DBS

First Report on the Frequency and Molecular Detection of Neuropathogenic EHV-1 in Turkey

There has been an increase in outbreaks of neuropathogenic equine herpesvirus-1 (EHV-1) in the United States and Europe. However, the presence and frequency of neuropathogenic EHV-1 in Turkish horses are not known at present. This study aimed to investigate the frequency of EHV-1 and neuropathogenic strains of EHV-1 in the Marmara Region of Turkey. Samples were analyzed for the presence of EHV-1 and neuropathogenic EHV-1 by real-time PCR TaqMan probe assays. Overall detection rate of EHV-1 was 45.5% (51 of 112). The detection rates were 70.5% (24 of 34) in aborted fetuses, 53.3% (8 of 15) in neonatal deads, 66.6% (4 of 6) in foals, 40% (2 of 5) in dead mares, and 25% (13 of 52) in living mares. Overall detection rate of neuropathogenic EHV-1 was 7.8% (4 of 51), and the real-time PCR results were confirmed by sequencing. Neuropathogenic strains of EHV-1 were detected in the brain and lung of two mares with neurological disease but without a history of abortion, in the brain of a foal that died of respiratory disorder, and in the nasal swab from a mare with a history of abortion. On histopathology, nonpurulent meningoencephalitis, hemorrhages, and vasculitis were seen in the brain. In conclusion, results of this study indicated, for the first time, that the neuropathogenic EHV-1 is circulating in the Marmara Region of Turkey. The results of this study also show that the current risk for non-neuropathogenic strains is high, whereas risk for the neuropathogenic ENV-I-G(2254) strain seems to be low. As outbreaks of EHV-1 continue in the Marmara region of Turkey, surveillance for neuropathogenic EHV-1 genotype should be maintained. (C) 2012 Elsevier Inc. All rights reserved