Skeletal Muscle Disease: Imaging Findings Simplified

Skeletal muscle is a major anatomic structural component of the human body. Myopathy, defined as skeletal muscle disease, may offend any of the body's 650 muscles and encompasses an extended array of acute and chronic abnormalities. Muscle disease can be categorized according to etiology as congenital, traumatic, infectious, or neoplastic. The concept of the diversity of multiple muscular disease processes signifies an important role for imaging in the detection and characterization of myopathy. However, despite the exquisite physiological properties of skeletal muscle, muscle imaging has not received attention equal to that of bones and joints. Accordingly, this article provides an indication of the most suitable imaging modalities for myopathy and reviews a multitude of primary and systemic muscle derangements, with an emphasis on magnetic resonance (MR) imaging findings. Because these patterns of MR imaging abnormality bespeak the widespread nature of myopathy, we illustrate typical examples of muscle disease processes to simplify diagnosis

Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed

Fibrosarcoma with deceptive benign presentations: a report of two cases

Low-grade fibromyxoid sarcoma and myxofibrosarcoma are malignant soft tissue tumors, fibrosarcomas, of shared clinical and imaging appearances. We report sarcomatous lesions in soft tissue with deceptively benign clinical and imaging appearances, and correlate findings with those of histologic analysis. Two patients presented with a long history of painless swelling at the dorsum and upper extremity and denied any constitutional symptoms. Sonography and magnetic resonance imaging suggested the presence of benign soft tissue lesions of a predominant fluid-like consistency. Despite indolent clinical and imaging characteristics, in both cases, histopathology disclosed a diagnosis of spindle cell-type soft tissue sarcoma, designating an aggressive tumor. Knowledge of the seemingly benign clinical and imaging features of fibrosarcomas is required to raise the possibility of malignancy in soft tissue that may be underdiagnosed or misdiagnosed. The importance of a correct diagnosis and the implications of surgical resection, irradiation, and systemic oncological therapy are quite obvious

Nora lesion (Bizarre parosteal osteochondromatous proliferation): An ultrasound diagnosis with magnetic resonance imaging correlation

Advanced cross-sectional imaging techniques are firmly established as a means of evaluating musculoskeletal disease, and ultrasound (US) is increasingly being used for the assessment of a diversity of tendon, joint, and soft-tissue abnormalities. A benign condition – bizarre parosteal osteochondromatous proliferation (BPOP) – arises from the periosteum, typically in the small bones of the hands and feet, and grows as a surface bone lesion in the surrounding soft tissue. Proliferations can become symptomatic, exercising mass effect on adjacent structures that may require operative management. As a bone-forming process, BPOP may occasionally assume worrisome histologic features that mimic sarcoma, and a pronounced tendency to recur after primary excision. A solitary mass was growing in the middle finger of a young woman that curtailed proper hand function. With US, a partially ossified formation was revealed in the proximal phalanx situated on the outer surface of the bone. There was faint acoustic shadowing distal to the lesion, and a hypoechoic halo was seen covering part of the abnormal tissue growth. Importantly, the lesion caused significant limitation of motion of the finger, on the dynamic flexion US images with the displacement of the flexor tendon and compression of a digital nerve. To restore the range of motion in the finger, surgical excision of the juxtacortical mass was performed and histology yielded a diagnosis of BPOP. We describe the US features of digital BPOP, which were found to correspond closely to those of computed tomography and magnetic resonance imaging

Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels

We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed