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The results of 79 high resolution ultrasound examinations of the forefoot that were performed for suspected Morton's metatarsalgia were retrospectively assessed. Scans were only obtained if the pain was poorly localized or if there were atypical features that made the clinical diagnosis uncertain. Ultrasound detected 92 hypoechoic intermetatarsal web space masses in 63 patients. Surgery was performed on 23 web spaces in 22 patients where the response to nonsurgical management had been poor. The surgical specimens were retrieved and reviewed by a pathologist in 21 cases. The histopathology in 20 of 21 operated cases was that of Morton's neuroma; however, prominent mucoid degeneration was also found to involve the adjacent loose fibroadipose tissues in 19 of 20 neuroma specimens. Ultrasound was sensitive in the detection of web space abnormality (sensitivity, 0.95), but could not clearly separate Morton's neuroma from associated mass-like mucoid degeneration in the adjacent loose connective tissues. The implications of these observations for both diagnosis and treatment are discussed.

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Vascular filling defects are a normal feature of the thoracic myelogram. The aim of this paper was to provide criteria for differentiating the vascular filling defects in spinal AVM's from the range of filling defects seen in non‐AVM patients. Out of 940 consecutive thoracic myelograms, in non‐AVM patients, 505 had vascular filling defects. These were compared with the myelographic features of nine spinal AVM's, with regard to vessel diameter, length, tortuosity and number. None of these criteria were diagnostic of AVM's as there was overlap bet ween the vascular filling defects of AVM's and the range of normal spinal cord vessels, especial ly posterior spinal veins. However, filling defects greater than 1.4 mm diameter, which are excessively tortuous, long and. multiple, should be regarded as highly suspinous of an AVM. A lateral film is important when vascular filling defects are seen, for if these filling defects are anterior to the cord, an AVM is more likely.

940 water soluble constrast thoracic myelograms were examined Vascular filling defects in the thoracic subarachnoid space were seen in 54% of patients overall, and in 88% of patients in whom the film quality and contrast density were high. Vascular filling defects were, therefore, concluded to be a normal feature of the thoracic myelogram. On analysis of the characteristics of these vascular patterns, there were no significant age or sex correlates, with the exception that the younger population (0–20 years) was found to have a smaller number of these discrete patterns, they being also less tortuous, of smaller diamter and of shorter length. The majority of vascular filling defects were found to be due to posterior spinal veins. A “hairpin” vascular filling defect in the caudal thoracic subarachnoid space, previously thought to be due to the arteria radicularis magna [artery of Adamkiewicz] was found to be more likely to be due to a posterior radicular vein. The above findings were correlated with dissected anatomical specimens.

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