Osteoblastoma of the femur in a patient with recurrent paronychia : case report

Background: Osteoblastoma is a rare primary benign bone tumor that has varied radiologic presentation depending on the affected site. In selected cases, differential diagnosis with subacute osteomyelitis is necessary. Case Report: The authors present the case of a 23 year-old male with recurrent paronychia diagnosed with osteoblastoma of the femur. On the basis of CT and MRI findings, osteosarcoma, ABC, enchondroma, chondromyxoid fibroma, and Brodie's abscess were excluded from differential diagnosis, with the last option being the second most probable diagnosis given the coexistence of chronic pyogenic process. Discussion: Plain film findings in osteoblastoma and Brodie's abscess may be strikingly similar with an osteolytic lesion surrounded by prominent sclerosis. The nature of the lesion can be further elucidated by cross-sectional imaging. CT helps to assess the lesion matrix and presence or absence of sequestra or fistulae, while MRI defines the extent of the changes in bone marrow cavity and soft tissues

Computed tomography-guided percutaneous radiofrequency and laser ablation for the treatment of osteoid osteoma : long-term follow-up from 5 to 10 years

Purpose: The impact of computed tomography (CT)-guided, percutaneous radiofrequency ablation and interstitial laser ablation (ILA) on the management of patients with osteoid osteoma was studied. This was carried out by assessing immediate and long-term clinical outcomes, the complication rate, and repeat therapy effectiveness in recurrent patients who have already experienced percutaneous ablation. Material and methods: Consecutive patients with osteoid osteoma were assessed before the interventional treatment in a single centre from 2010 to 2015. Patient demographics, complications, and recurrence were recorded. The pain was evaluated with Visual Analogue Scale (VAS). Percutaneous procedures were performed by means of radiofrequency thermoablation or ILA. Epidural or regional anaesthesia in the CT suite was applied in all procedures. Success, whether primary or secondary, was measured as complete pain relief without evidence of recurrence after the first or second procedure, respectively. Osteoid osteoma characteristics, procedure overview, and technical success were looked for in pre-procedural and procedural scans. Results: Eighty-three per cent of osteoid osteomas were located in lower extremities, 56% of tumours were intracortical, and 83% of osteoid osteomas were extra-articular. The mean pre-procedure VAS score was 8.5 ± 0.8, while the overall primary success rate of radiofrequency thermoablation and ILA was 87.5%. No major complications were noted. The mean follow-up period for patients in was 7.5 years (5.0-10.2 years). Conclusions: Percutaneous, CT-guided thermoablation proved to be effective and should become the method of choice in osteoid osteoma treatment because of its minimal invasiveness. Our results show that there is no risk of very late recurrence after achieving primary and secondary treatment success

Osteochondrosis dissecans of the knee : evaluation of the evolution of MR morphology during treatment

Background: To assess the evolution of MR morphology of OCD lesions in response to treatment and feasibility of MRI as a control study in patients with treated OCD. Material/Methods: 11 patients (6 women and 5 men, aged 11-24 years, average age 17 years) with lesions affecting 12 knee joints were followed for approximately 24.2 months with repeated clinical examination and MR imaging. All MR studies were performed on a 1.5 Tesla unit. MR arthrography was performed in 3 patients. The evolution of MR morphology of the lesions was assessed with a 5-point scale and correlated with the results of clinical assessment with a modified Lysholm scale. Results: In 10 patients, a good clinical result was achieved. In 7 knee joints of patients from this group, the features of the healing of the OCD lesion were observed in MRI and in 4 knees the morphology of the OCD lesion was stable. In 5 MR examinations, a transient deterioration was observed, which in 4 cases preceded healing and in 1 case stabilization in MR morphology. Conclusions: Transient deterioration may be observed in MR studies prior to the healing of OCD lesions irrespective of the improvement in clinical examination. The follow up of patients with OCD should be based mainly on clinical examination, with MR studies reserved for late control or patients with clinical signs of deterioration

A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis : clinical and computed tomography features

Purpose: Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gasforming bacteria - most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report: An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions: Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis

Natural history of intracranial aneurysms in autosomal dominant polycystic kidney disease

Autosomal-dominant polycystic kidney disease (ADPKD) is a relatively frequent genetic disorder that is associated with increased prevalence of intracranial aneurysms (IAs). However, evidence on the natural history of IAs in ADPKD is suboptimal. That leads to difficulties in development of recommendations on surveillance on patients with IAs in their medical history, or the need for repeat imaging for IAs in those with a negative result of the initial screening. The aim of the article is to present our experience on the natural history of IAs in ADPKD patients. Material and methods Thirty-four ADPKD patients, managed at our outpatient department, with imaging for intracranial aneurysms performed at least twice, were included into present retrospective analysis. Results Among 8 patients with an IA in their medical history, no new IA was observed during 93 patient-years of follow-up. In 6 patients with untreated, unruptured IAs, IA growth was observed in 2 cases during 32 patient-years of follow-up. Finally, among 20 patients with a negative result of initial screening, 2 new IAs were noticed during 115 patient-years of follow-up, including 1 patient with a positive family history for an IA, and 1 patient without a family history. Conclusions Our observations support repeat imaging for IAs in patients with ADPKD, positive family history of IA, and negative result of initial screening. Additionally, efforts should be made to develop clinical and/or laboratory risk factors for IAs development in ADPKD patients without family history of IA, which enable to identify patients who should undergo repeat imaging for IAs

The comparative analysis of magnetic resonance imaging and arthroscopy of the temporomandibular joints

Background: The aim of the study was to correlate arthroscopic and MRI image of temporomandibular joints (TMJ) dysfunction on the clinical basis. Material/Methods: The study sample comprised 44 patients. All subjects underwent bilateral MRI and unilateral arthroscopy of TMJ to evaluate disc structure, position and function, bone structure abnormalities, joint effusion localization and entity according to Wilkes classification. Results: In 31 patients (70,5%) MRI allowed diagnosing the morphological and functional changes with the arthroscopic confidence. In 13 (29,5%) cases the differences between both images were noted. The stage of the disease was over- or underestimated at one grade level. Conclusions: The present study contributes to an improved understanding of TMJ changes in MRI. The MRI analysis of craniomandibular disorders is extremely helpful as the primary imaging preceding arthroscopy

The value of ultrasonography in the diagnosis of varicocele

A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection. In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. The width and the number of vessels in the pampiniform plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment. However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy

Profil hormonalny u kobiet chorych na stwardnienie rozsiane w powiązaniu z aktywnością choroby — doniesienie wstępne

Background and purpose The influence of sex hormones on immune system activity in multiple sclerosis (MS) has been suggested by clinical evidence. The aim of the study was to analyse the pattern of sex hormones in MS women and to correlate the hormone pattern abnormalities to the disease course as well as to the magnetic resonance imaging (MRI) results. Material and methods We studied the serum level of the progesterone, β-oestradiol and prolactin in 46 women with clinical definite MS aged from 19 to 65; mean disease duration was 11.80 ± 9.86 years. The evaluation of the intensity of hormonal changes was done using a scoring system (0–3). On the brain MRI, the presence of brain atrophy, of hypothalamic demyelination as well as demyelination intensity (or degree) were analysed. The evaluation of the degree of demyelination and brain atrophy was done using a scoring system (0–4). Results The main hormonal abnormalities consisted of decreased progesterone level, increased oestradiol level or both. The sex hormone pattern was abnormal in 56% of patients. Hypothalamic lesions were found on MRI in 53% of cases. The abnormal hormonal pattern correlated with intensity of MR changes (p < 0.05, Fisher's exact test), but neither with presence of hypothalamic changes nor with disease parameters (Expanded Disability Status Scale, relapse rate, disease duration). Conclusions It is important to check the hormonal pattern in MS women because according to our results it may be related to the disease activity and probably affects the type of therapeutic intervention. This pilot study will be extended in a larger population.Wstęp i cel pracy Dane z piśmiennictwa sugerują częste występowanie zaburzeń hormonalnych u kobiet chorych na stwardnienie rozsiane (SR). Celem pracy była analiza profilu hormonalnego w zakresie hormonów płciowych u kobiet z SR w powiązaniu z przebiegiem klinicznym i obrazem rezonansu magnetycznego (RM) mózgowia. Materiał i metody Badano stężenie progesteronu, β-estradiolu i prolaktyny w surowicy u 46 pacjentek z klinicznie pewnym SR, w wieku od 19 lat do 65 lat, o średnim czasie trwania choroby 11,80 ± 9,86 roku, niestosujących żadnej terapii hormonalnej. Stopień zmian w profilu hormonalnym oceniano półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—3).W analizie RM brano pod uwagę obecność ognisk demielinizacji w obrębie struktur podwzgórza, nasilenie demielinizacji w obrębie mózgowia oraz współistnienie zaniku mózgu. Stopień zmian w RM oceniano także półilościowo wg przyjętego arbitralnie przez autorów systemu punktacji (0—4). Wyniki Nieprawidłowe stężenia hormonów stwierdzono u 26 pacjentek (56%). Nieprawidłowości polegały na zmniejszonym stężeniu progesteronu, zwiększonym stężeniu 17-β-estradiolu bądź na łącznym występowaniu obu tych zaburzeń. W badaniu RM w 53% przypadków stwierdzono obecność zmian demielinizacyjno-zapalnych w obrębie podwzgórza. Stopień zaburzeń hormonalnych oceniany półilościowo korelował ze stopniem zmian w RM mózgowia (p < 0,05; test dokładny Fishera), nie był natomiast związany z obecnością zmian w obrębie podwzgórza czy parametrami klinicznymi (punktacja w Expanded Disability Status Scale, częstość rzutów, czas trwania choroby). Wnioski Stan hormonalny kobiet chorych na SR powinien być brany pod uwagę w analizie klinicznej choroby i przy decyzjach terapeutycznych, gdyż wydaje się mieć związek z aktywnością SR. Badania te, w celu potwierdzenia uzyskanych wyników, należy kontynuować na szerszym materiale