KEYWORDSSonography; Knee; Overload syndromes.Abstract Overload syndromes are caused by repetitive microtrauma, and the knee joint is most frequently affected in adolescents. The reason for this is that the knee joint is engaged in almost all sports activities. Pathologies related to the anterior aspect of the knee are: femoropatellar pain, jumper's knee syndromes, OsgoodeSchlatter disease, Sinding-Larsene Johansson syndrome and patellar stress fractures; to the medial aspect: semimembranous tendon enthesopathy and pes anserinus bursitis; to the lateral aspect: iliotibial band syndrome (runner's knee), popliteus and femoral biceps tendon enthesopathy; to the posterior aspect: fabella syndrome and medial gastrocnemius muscle tendon enthesopathy. Sonography plays a central role in the diagnosis and can also evaluate the evolution of diseases. This method is well accepted by the patients and by their parents, it does not involve exposure to X-rays and it is inexpensive. US imaging should, therefore, be considered a first-line imaging diagnostic technique in functional overuse syndromes of the knee.Sommario Le sindromi da sovraccarico riconoscono come causa principale i microtraumi ripetitivi e il ginocchio è l'articolazione interessata più frequentemente negli adolescenti. La ragione è legata al fatto che il ginocchio è particolarmente sollecitato in tutte le attività fisiche, sia della vita quotidiana sia nelle attività agonistiche. Possono essere interessate varie strutture con conseguenti e diverse patologie, in particolare nel comparto anteriore si realizzano lesioni dell'articolazione femoro-rotulea, del tendine rotuleo (jumper's knee), le sindromi di Osgood-Schlatter e di Sinding-Larsen-Johansson, fratture da stress della rotula; nel comparto mediale la sindrome della plica sinoviale, tendinopatie del tendine del semimembranoso, borsiti della borsa della zampa d'oca; nel comparto laterale la sindrome da frizione della bendelletta ileo-tibiale (runner's knee), tendinopatie del tendine popliteo e del bicipite; nel comparto posteriore patologie legate alla fabella e al tendine del gemello mediale. L'ecografia è in grado porre diagnosi e di valutare il decorso della malattia nella grande maggioranza di queste lesioni, è ben accetta ai pazienti e ai genitori per l'assenza di controindicazioni e di radiazioni ionizzanti, ha costi contenuti ed è pertanto l'esame di scelta nelle sindromi da sovraccarico del ginocchio nell'adolescente. Richiede esperienza e l'integrazione di radiologia tradizionale, TC e RM in alcuni casi quali l'inquadramento delle malformazioni e il disallineamento degli arti inferiori. ª
Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.
Background Mucoid degeneration and ganglia reflect a continuum of degenerative changes within the posterior cruciate ligament (PCL). Purpose To assess the prevalence of and radiologists' familiarity with PCL mucoid degeneration and ganglia. Material and Methods Knee magnetic resonance imaging (MRI) from July 2013 to June 2015, excluding patients who had a preceding trauma or MRI findings indicative of a prior injury, were retrospectively reviewed, with the specific request to assess degenerative changes of the PCL, by the same musculoskeletal radiologists who previously reported these examinations, and one fellow. Results A total of 692 patients entered this study. The radiologists and the fellow together identified mucoid degeneration in 34 patients (4.9%), ganglia in 14 patients (2.0%), and both in four patients (0.6%). Several patterns of PCL mucoid degeneration were identified: diffuse thickening in seven patients, partial thickening in 16 (four associated with a ganglion), longitudinal intraligamentous PCL signal-intensity abnormalities resembling a "tram track" in 15. In all cases there was increased signal intensity on fluid-sensitive sequences. In the previous reports, only three cases of PCL mucoid degeneration out of 38 (7.9%) were described, with intraligamentous PCL signal-intensity abnormalities. In the reports of the patients with degeneration and ganglia, only ganglia were described. In the previous reports, ganglia were correctly diagnosed. Conclusion Mucoid degeneration of the PCL is much more common than previously assumed and is underestimated by radiologists.
Enthesitis of the direct tendon of the rectus femoris muscle is a rare pathology which mainly affects professional athletes, and it is caused by overuse and repetitive microtrauma. Athletic jumping and kicking exert a great stress on the direct tendon of the rectus femoris muscle, and volleyball and football players are therefore most frequently affected. Enthesitis may occur suddenly causing pain and functional impairment possibly associated with partial or complete tendon injuries, or it may be a chronic condition causing non-specific clinical symptoms. We present the case of a professional volleyball player who felt a sudden pain in the left side of the groin area during a training session although she had suffered no accidental injury. The pain was associated with impaired ipsilateral limb function. Tendon rupture was suspected, and magnetic resonance imaging (MRI) was performed. MRI showed a lesion at the myotendinous junction associated with marked inhomogeneity of the direct tendon. Ultrasound (US) examination confirmed the presence of both lesions and allowed a more detailed study of the pathology. This is a typical case of enthesitis which confirms that MRI should be considered the examination of choice in hip pain, particularly when the patient is a professional athlete, thanks to its panoramic visualization. However, also US is an ideal imaging technique for evaluating tendon injuries thanks to its high spatial resolution, and it can therefore be used effectively as a second line of investigation.Sommario Le entesiti del tendine diretto del muscolo retto femorale sono rare e pressoché esclusive degli atleti professionisti, legate a sovraccarico funzionale e microtraumi ripetuti. Il gesto atletico del salto e del calcio sono quelli che maggiormente sollecitano il tendine diretto del retto femorale e quindi calciatori e pallavolisti rappresentano gli atleti più frequentemente colpiti. Le entesiti possono presentarsi in maniera acuta, con dolore e impotenza funzionale, eventualmente associati a lesioni parziali o complete del tendine, o cronica con quadri clinici più sfumati. Presentiamo il caso di una pallavolista professionista che, nel corso di un allenamento (in assenza di traumi), manifestava una sintomatologia dolorosa inguinale sinistra e impotenza funzionale dell'arto omolaterale. Nel sospetto di rottura tendinea, veniva effettuata una risonanza magnetica che mostrava una lesione a livello della giunzione mio-tendinea, associata a marcata disomogeneità del tendine diretto. L'ecografia permetteva di confermare la presenza di entrambe le lesioni e di meglio definire le caratteristiche dell'entesite. Il caso in esame è tipico e conferma come la risonanza magnetica, per la sua panoramicità, sia da considerare l'esame di scelta nel dolore dell'anca, in particolare negli atleti professionisti; tuttavia, l'ecografia, per l'elevata risoluzione spaziale, si presenta come la tecnica di imaging ideale per la valutazione delle lesioni tendinee e può pertanto essere utilmente impiegata come esame di ...
KEYWORDSRheumatoid arthritis; Septic arthritis; Ultrasonography; Magnetic resonance imaging.Abstract Purpose: Septic arthritis (SA), frequently involving hand and wrist, is common in rheumatoid arthritis (RA) patients due to immunomediated etiology of RA and immunosuppressive drug use. Clinical and laboratory features might not be useful to differentiate between RA relapse and superimposed SA. The role of magnetic resonance imaging (MRI) has been described in several studies. Our aim is to evaluate the role of ultrasonography (US). Material and methods: In the last 4 years 31 MRI of hand and wrist has been performed in the suspect of SA complicating RA. A 1.5 T unit (Siemens Symphony, Erlangen, Germany) with standardized protocol, involving the administration of contrast medium, was used. Also US with power Doppler evaluation was performed. A Philips IU22 US scanner was used. Results: Eleven points (according to Graif's study) were analyzed for every MRI and US. At MRI joint effusion (37.5% of RA relapse vs 100% superimposed SA) and soft tissue edema (25% vs 100%) were indicative of SA. At US joint effusion (31.3% of RA relapse vs 73.3% superimposed SA) and soft tissue edema (12.5% vs 60%) were indicative of SA. Conclusion: Our results suggest that joint effusion and soft tissue edema are markers suggestive for superimposed SA and that MRI is more sensitive in their evaluation. Although US is less sensitive than MRI, the former is important in guiding invasive procedure and evaluating patients that cannot undergo MRI.Sommario Scopo del lavoro: L'artrite settica (SA), che spesso coinvolge mano e polso, è comune nei pazienti con artrite reumatoide (AR) a causa dell'eziologia immunomediata della AR e dell'uso di farmaci immunosoppressivi. Le caratteristiche cliniche e di laboratorio possono non essere utili per distinguere tra recidiva di AR e sovrapposizione di SA. Il ruolo della risonanza magnetica (RM) è stata descritto in diversi studi. Il nostro obiettivo è quello di valutare il ruolo della ecografia (US). Materiali e Metodi. Negli ultimi 4 anni sono stati eseguiti 31 esami di risonanza magnetica della mano e del polso nel sospetto di SA come complicanza di AR. È stata utilizzata una risonanza magnetica da 1.5 T (Siemens Symphony, Erlangen, Germania) con protocollo standardizzato, che comprendeva la somministrazione di mezzo di contrasto; * Corresponding author.E-mail address: chandra.bortolotto@gmail.com (C. Bortolotto).1971-3495/$ -see front matter ª 2012 Elsevier Srl. All rights reserved. doi:10.1016/j.jus.2012.03.004Available online at www.sciencedirect.com j ourna l home page: www.el sevier.com/loca te/ jusJournal of Ultrasound (2012) 15, 115e120 è stata eseguita anche un'ecografia con power Doppler utilizzando un ecografo Philips IU22. Risultati: Sono stati analizzati undici punti (secondo lo studio di Graif) per ogni esame di RM e di US. Alla RM il versamento articolare (37,5% di recidiva AR vs 100% sovrapposizioni di SA) e l'edema dei tessuti molli (25% vs 100%) erano indicativi di SA. Anche ecografica...
Iatrogenic injuries of the median nerve after surgical release for carpal tunnel syndrome resulting in the formation of a neuroma are rare. We present here the case of two patients, one with a bifid median nerve, showing in-continuity neuroma after surgical release for carpal tunnel syndrome. The patients reported persistent post-operative pain and showing symptoms. In both cases, ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the carpal tunnel. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and it is useful for evaluation of the percentage of the area affected by the tear.
Pathological breast conditions are rare in childhood and adolescence. The spectrum of breast disease in pediatric patients is different from that in adults and most lesions are benign. Fibroadenomas are the most common type of breast tumor in adolescent girls and young women. These lesions occasionally develop into very large masses, particularly in adolescent girls. Such masses are called solitary giant juvenile fibroadenomas, and local recurrence is unusual. We report here a case of recurrent juvenile giant breast fibroadenoma in a girl with Turner's syndrome.
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