Spectrum of skeletal disorders during the peripartum period: MRI patterns

Pregnancy is a normal condition in which a combination of biomechanical and hormonal changes may result in a wide spectrum of skeletal disorders. Skeletal overloading due to postural and weight changes, combined with increased ligamentous laxity stemming from the action of relaxing and the risk of pregnancy-related osteoporosis during childbearing, childbirth, and postpartum, have been associated with various pathologies. Owing to the heterogeneity of proposed contributing factors, skeletal lesions in the peripartum period may be related to different pathogenesis depending on the metabolic status of the patient and the degree of biomechanical stress; thus, a fatigue or insufficiency discrimination is not always easy to make. When combined with clinical data, magnetic resonance imaging (MRI) is a powerful tool in clarifying the cause of skeletal pain in the majority of patients or alerting clinicians to proceed to further investigations. Early detection and tailored treatment are important in order to avoid disease progression and long-term restriction of daily activities which may have an adverse impact on the relationship between the mother and the newborn. This pictorial essay provides an overview of the MRI characteristics and pattern of involvement of skeletal lesions presenting during the peripartum period, combined with demographic data and dual-energy X-ray absorptiometry (DEXA) measurements

Magnetic resonance imagine evaluation of medial hamstring tendons regeneration after harvesting for anterior cruciate ligament reconstruction

In our study we evaluate the regeneration of medial hamstring tendons (semitendinosus and gracilis) after harvest for anterior cruciate ligament reconstruction (ACLR) by using magnetic resonance imaging (MRI). The aim of the study is to describe in detail all the changes happening at the donor site after tendon harvest. MRI estimates the regeneration process of medial hamstring tendons as well as the muscles and musculotendinous junctions of semitendinosus and gracilis. Fourty-seven patients who had undergone ACLR with medial hamstring tendons were studied with MRI of the affected knee and the knee-femurs between 2004 and 2007 by using the knee coil and the body coil respectively. The study included 42 males with an average age of 27,61 years (range, 17 to 42 years) and 5 females with an average age of 31 years (range, 20 to 51 years). The regenerated tendons were estimated along the harvest site among three positions: the upper pole of the patella, the knee joint line and the pes anserinus. The regenerated tissue, when present, was characterized as "incomplete", if the neotendon does not cross the joint line or "complete" if the neotendon crosses the joint line of the knee. Complete semitendinosus and gracilis tendon regeneration was present in 64% and 36% of the patients respectively. The T1-WI SE/TSE precisely evaluates the insertion anatomy of the regenerated tendons, which is a point of controversy. Of all the cases described, the one receiving the greatest amount of attention, with probable clinical implications, is the regeneration of the tendons at the level of the pes anserinus, which is described as "anatomic regeneration". By using axial and coronal T1-W1 SE/TSE, we conclude that tendon maturation occurs uniformly along the length of the neotendon. Furthermore, the neotendon evolves through a process of remodeling. Initially, the cross-sectional area of the neotendon is greater than normal, but over time as the structure solidifies, its diameter also decreases. Both the semitendinosus and gracilis muscles showed ceplalad retraction in 88% of the patients, which was characterized as mild, moderate or severe. Fatty infiltration in the semitendinosus muscle was present in 53% of the patients, whereas in the gracilis muscle it was present in 35% of the patients and characterized as mild, moderate or severe. The cross-sectional area of the semitendinosus muscle was reduced in ail patients examined, whereas the cross-sectional area of the gracilis muscle was reduced in 85% of the patients. Finally, axial and coronal STIR images showed abnormal signal within semitendinosus and gracilis muscles in 46% and 64% of the patients examined respectively. In conclusion, we believe that MRI, with its high resolution and the ability of multiplanar imaging, enables precise evaluation of subtle structures, such as tendons and depicts in detail the ongoing process of complex phenomena, such as semitendinosus and gracilis tendon regeneration after harvesting for ACLR.Στην παρούσα διδακτορική διατριβή, μελετήθηκε το φαινόμενο της ανάπλασης των τενόντων των οπισθίων-έσω μηριαίων μυών (ημιτενοντώδης και ισχνός) με μαγνητική τομογραφία (MT) μετά από τη χρήση τους στη συνδεσμοπλαστική του προσθίου χιαστού συνδέσμου του γόνατος (ΠΧΣ). Πρόκειται για μια αναλυτική μορφολογική μελέτη, η οποία έχει ως στόχο να αναδείξει την ανατομία της νέας κατάστασης που δημιουργείται στη δότρια περιοχή μετά την αφαίρεση των τενόντων των οπισθίων-έσω μηριαίων μυών. Μελετάται τόσο το φαινόμενο της «αναγέννησης» των τενόντων του ημιτενοντώδους και του ισχνού μυός όσο και οι ίδιοι οι μύες και οι μυοτενόντιες συμβολές. Στη μελέτη συμμετείχαν 47 ασθενείς (42 άνδρες, ηλικίας από 17 μέχρι 42 έτη και 5 γυναίκες, ηλικίας από 20 μέχρι 51 έτη), οι οποίοι υποβλήθηκαν σε επαναλαμβανόμενες προγραμματισμένες εξετάσεις ΜΤ του χειρουργημένου γόνατος και των μηρών, από 10/12/2004 έως και 10/08/2007. Έγινε εκτίμηση της παρουσίας «αναγεννημένου» ιστού στην πορεία της χειρουργικής εκτομής των τενόντων του ημιτενοντώδους και του ισχνού μυός περιφερικά μεταξύ τριών θέσεων, που επέτρεψε να χαρακτηρίσουμε την ανάπλαση των τενόντων «ατελή» και «πλήρη». Συνολικά, παρατηρήθηκε «πλήρης» ανάπλαση του τένοντα του χειρουργημένου ημιτενοντώδους μυός σε ποσοστό 64% των ασθενών, ενώ «πλήρης» ανάπλαση του τένοντα του χειρουργημένου ισχνού μυός διαπιστώθηκε σε ποσοστό 36%. Η Τ1-WI SE/TSE ακολουθία καθόρισε με ακρίβεια τη θέση πρόσφυσης των «νεοτενόντων» του ημιτενοντώδους και του ισχνού μυός και τη σχέση τους με παρακείμενες ανατομικές δομές. Ιδιαίτερο ενδιαφέρον, με πιθανές κλινικές προεκτάσεις, παρουσιάζει η περίπτωση «ανατομικής αναγέννησης», δηλαδή φυσιολογικής πρόσφυσης των «νεοτενόντων» στο χήνειο πόδα. Με τη βοήθεια των εγκάρσιων και στεφανιαίων τομών των γονάτων-μηρών σε T1-WI TSE ακολουθία, καταλήξαμε στο συμπέρασμα ότι η «αναγέννηση» των τενόντων των οπισθίων-έσω μηριαίων μυών λαμβάνει χώρα ομοιόμορφα κατά μήκος της περιοχής εκτομής των τενόντων. Διαπιστώθηκε κεντρική σύσπαση τόσο του χειρουργημένου ηνιτενοντώδους όσο και του ισχνού μυός σε ποσοστό 88% των ασθενών. Παρατηρήθηκε επίσης λιπώδης ατροφία του χειρουργημένου ημιτενοντώδους μυός σε ποσοστό 53% και του χειρουργημένου ισχνού μυός σε ποσοστό 35% των ασθενών. Η επιφάνεια διατομής του χειρουργημένου ημιτενοντώδους μυός ήταν ελαττωμένη σε όλες τις εξετάσεις που πραγματοποιήθηκαν, ενώ η επιφάνεια διατομής του χειρουργημένου ισχνού μυός ήταν ελαττωμένη σε ποσοστό 85% των ασθενών. Τέλος, οι εγκάρσιες και στεφανιαίες τομές σε STIR ακολουθία κατέδειξαν την παρουσία παθολογικά υψηλής έντασης σήματος στο χειρουργημένο ημιτενοντώδη και ισχνό μυ σε ποσοστό 46% και 64% αντίστοιχα. Η ΜΤ, με την εξαιρετική χωρική διακριτική ικανότητα και τη δυνατότητα πολυεπίπεδης απεικόνισης που διαθέτει, μπορεί να απεικονίσει με ακρίβεια την εξελικτική πορεία σύνθετων φαινομένων, όπως αυτό της «αναγέννησης» των τενόντων των οπισθίων-έσω μηριαίων μυών μετά από τη χρήση τους στη συνδεσμοπλαστική του ΠΧΣ

Lipoma Arborescens of the Knee: Report of Three Cases and Review of the Literature

Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, which is characterized by villous proliferation of the synovium, with replacement of the subsynovial connective tissue by mature fat cells. It usually involves the suprapatellar pouch of the knee joint. It is not a neoplasm but is rather considered a nonspecific reactive response to chronic synovial irritation, due to either mechanical or inflammatory insults. We report three cases of lipoma arborescens affecting the knee, the first in a young male without previous history of arthritis or trauma, the second in a 58-year-old male associated with osteoarthritis, and the final in a 44-year-old male diagnosed with psoriatic arthritis, which cover the entire pathologic spectrum of this unusual entity. We highlight the clinical findings and imaging features, by emphasizing especially the role of MRI, in the differential diagnosis of other, more complex intra-articular masses

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

Abstract Background There are an estimated 1–2 cases per million per year of adrenocortical carcinoma in the USA. It represents a rare and aggressive malignancy; it is the second most aggressive endocrine malignant disease after anaplastic thyroid carcinoma. Non-secretory adrenal masses are diagnosed late due to a mass effect or metastatic disease or found incidentally (adrenal incidentalomas). Case presentation The first case report describes a 39-year-old Greek woman who presented to our department with complaints of repeated symptoms of flatulence and epigastric discomfort over a few months. The second case report is about a 67-year-old Greek woman who presented to our department after being evaluated for fatigue, mass effect, and epigastric discomfort. Both of them were diagnosed as having a nonfunctioning adrenocortical carcinoma and underwent open adrenalectomy. Conclusions Approximately 60% of patients with adrenocortical carcinoma present with symptoms and signs of hormonal secretion. Our cases’ adrenocortical carcinomas were not functional. Hormone secretion is not a discriminating feature between benign and malignant adrenocortical masses. The silent clinical nature of nonfunctioning adrenocortical carcinoma results in late diagnosis, while the majority of patients present with locally advanced and/or metastatic disease. Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis that can be diagnostically challenging and demands high clinical suspicion. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant

Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries

ObjectiveTibial stress injuries are challenging in terms of early diagnosis, management strategy, and safe return-to-play. In the present study, pain production associated with the application of therapeutic ultrasound (TUS) was used as a primary diagnostic tool to assess tibial bone stress injuries, and the sensitivity of this procedure was compared with Magnetic Resonance Imaging (MRI).Subject and methodsThe study was designed as a retrospective analysis of prospectively collected data on tibial bone stress injuries in elite Track and field athletes attending the National Track and Field Athletics Centre in Thessaloniki, Greece, in the period 1995–2007. All patients underwent evaluation by TUS, and the sensitivity of the procedure was compared with MRI.ResultsFour of 29 athletes showed a positive TUS examination for stress injury while MRI showed normal findings. Additionally, 5 athletes evidenced MRI findings typical of a tibial bone stress injury, while TUS evaluation was negative. Using MRI as the standard, TUS displayed a sensitivity of 79.2%.ConclusionTherapeutic ultrasound is a reproducible modality with satisfactory reliability and sensitivity related to MRI, and could represent a useful tool for clinicians to primarily assess suspected tibial bone stress injuries in high qualification Track and Field athletes

Therapeutic Ultrasound in Navicular Stress Injuries in Elite Track and Field Athletes

To ascertain whether therapeutic ultrasound (TUS) can be used to assess the progression of conservative management in navicular stress injuries

Correction to: Giant nonfunctioning adrenal tumors: two case reports and review of the literature

In the publication of this article [1], there is an error in the Family Name and Given Name of the authors since these were interchanged

A Rare Variation of Transverse Testicular Ectopia (TTE) in a Young Adult as an Incidental Finding during Investigation for Testicular Pain

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare clinical entity. Herein, we present a case of a 19-year-old patient with persistent left testicular pain lasting for a week. Clinical examination revealed an empty right hemiscrotum, a normal left-sided descended testis, and in close proximity a mass-like structure resembling testicular parenchyma. Laboratory tests were significant for elevated follicle-stimulating hormone (FSH), while sperm count revealed azoospermia. Ultrasound imaging (US) of the scrotum demonstrated the presence of both testes in the same left hemiscrotum with varicocele and no signs of inguinal hernia. Magnetic resonance imaging (MRI) of the penis and scrotum revealed TTE with a single, fused vas deferens, and hypoplastic seminal vesicles. Surgical intervention by means of microsurgical sperm retrieval and transseptal orchidopexy were considered but not performed, primarily owing to the patient’s unwillingness and to a lesser extent due to the restriction that the short and fused vas would pose in an attempt to transpose the ectopic testis. Therefore, an annual follow-up was recommended