MATERIALS AND METHODS:Fourteen fresh cadaveric knees (obtained and used according to institutional guidelines, with informed consent from relatives of the deceased) from 11 men and three women (six left knees, eight right knees; age range, 70 -82 years at time of death; mean age, 76 years Ϯ 4.4 [standard deviation]) were studied with high-spatial-resolution MR imaging performed before and after intraarticular injection of 35-45 mL gadopentetate dimeglumine. MR images were evaluated by two readers in consensus, with emphasis on location of fluid posterior to the posterior cruciate ligament, communication of that fluid with the medial or lateral compartment of the knee, and the relation of fluid to surrounding structures. Readers also were asked to measure, in the sagittal plane, the distance between the posterior capsular insertion sites and the femoral physeal scar. For anatomic analysis, cadaveric specimens were sectioned in 3-mm-thick slices in the sagittal plane that approximated the sections acquired at MR imaging. RESULTS:In all 14 cadaveric specimens, MR arthrographic images showed a fluid collection behind the posterior cruciate ligament (in the posterior cruciate ligament recess), a finding not evident on images obtained prior to contrast material injection. The recess was distended during flexion, and it communicated only with the medial femorotibial compartment in all cases. Posterior to the posterior cruciate ligament recess, a fat pad was observed in all specimens. Incomplete joint capsule was seen behind the fat pad in seven specimens. Joint capsule insertion was at the level of the femoral physeal scar or between it and a point 15 mm above it. CONCLUSION:The posterior cruciate ligament recess has specific characteristics that allow its identification: communication with the medial compartment of the knee and absence of the adjacent joint capsule.The fibrous capsule of the knee is complex, is an incomplete compartment, and is partly augmented by extensions of adjacent tendons. Its posterior vertical fibers are attached proximally to the posterior margins of the femoral condyles and intercondylar fossae and distally to the posterior margins of the tibial condyles and intercondylar areas (1). The many different tendinous and ligamentous structures that are attached to the joint capsule provide capsular reinforcement. Proximally, medially, and laterally, the joint capsule is attached to the tendinous heads of the gastrocnemius muscle. In the posteromedial corner, the joint capsule also receives fibers from the tendon of the semimembranosus muscle and posterior oblique ligament. In its posterolateral corner, the joint capsule is reinforced by fibers of the arcuate ligament and iliotibial tract. Posteriorly and centrally, the oblique popliteal ligament strengthens the joint capsule (2). 968

A 2-month-old female patient presented an extensive bilateral parotid hemangioma (PH) focally ulcerated. Additionally, hepatic ultrasonography revealed a hemangioendothelioma located at right lobe. She was treated with oral prednisolone (3 mg/kg/day) during 10 months with clinical improvement of PH, despite failure to thrive and arterial hypertension. However, regrowth of the lesion occurred after discontinuation of oral steroid. Propranolol hydrochloride (2 mg/kg/day divided into two doses) was then started and maintained for 16 months, with marked involution of the hemangioma and with no systemic side effects during treatment course. Curiously, also the liver hemangioendothelioma completely resolved after starting propranolol. PH is a threatening cervicofacial segmental hemangioma that frequently proliferates after the year of age and needs long-term treatment. On the other hand, hepatic hemangioendotheliomas may be associated with cutaneous hemangiomas in some patients and their natural history is similar to these, although patients may die of associated conditions. As for other infantile hemangiomas, propranolol proved to be an effective, safe, and well-tolerated treatment for PH. Its role in liver hemangiomas and hemangioendotheliomas should also be taken into account.

IntroductionAcute fibrinous and organizing pneumonia (AFOP) is a rare diffuse pulmonary disease, but it is not yet known whether it is a distinct form of interstitial pneumonia or simply a reflection of a tissue sampling issue.MethodsCross-sectional evaluation of clinical and radiological findings, treatments, and outcomes for patients with histologically confirmed AFOP at a tertiary university hospital between 2002 and 2015.ResultsThirteen patients (7 women, 53.8%) with a mean ± SD age of 53.5 ± 16.1 years were included. The main symptoms were fever (69.2%), cough (46.2%), and chest pain (30.8%). All patients presented a radiological pattern of consolidation and 5 (38.5%) had simultaneous ground-glass areas. Histology was obtained by computed tomography-guided transthoracic biopsy in 61.5% of cases and by surgical lung biopsy in the remaining cases. Several potential etiologic factors were identified. Eight patients (61.5%) had hematologic disorders and 3 had undergone an autologous hematopoietic cell transplant. Two (15.4%) had microbiologic isolates, 5 (38.4%) had drug-induced lung toxicity, and 2 (15.4%) were classified as having idiopathic AFOP. In addition to antibiotics and diuretics used to treat the underlying disease, the main treatment was corticosteroids, combined in some cases with immunosuppressants. Median survival was 78 months and 6 patients (46.2%) were still alive at the time of analysis.ConclusionOur findings for this series of patients confirm that AFOP is a nonspecific reaction to various agents with a heterogeneous clinical presentation and clinical course that seems to be influenced mainly by the severity of the underlying disorder.

IntroductionRecent studies have reported a high prevalence of obstructive sleep apnoea (OSA) among patients with diffuse parenchymal lung disease (DPLD), mainly idiopathic pulmonary fibrosis (IPF). Effective OSA treatment appears to have a positive impact on morbidity and mortality in these patients. However, poor compliance to positive airway pressure (PAP) treatment in fibrotic DPLD patients has been reported. The aims of our study were to characterize patients with fibrotic DPLD and OSA and to assess their compliance to PAP treatment.MethodsForty-nine patients with fibrotic DPLD underwent level III polysomnography. Auto-adjusting PAP (APAP) treatment was proposed for those patients with moderate-to-severe OSA and those with mild OSA with daytime sleepiness and/or cardiovascular disease. The APAP treatment compliance was assessed after 1 month of therapy.ResultsThe distribution of the 49 fibrotic DPLD patients included was as follows: 21 with chronic hypersensitivity pneumonitis, 12 with IPF, 10 with connective-tissue associated DPLD, 4 with stage IV sarcoidosis, 1 with idiopathic pleuropulmonary fibroelastosis, and 1 with DPLD-associated vasculitis. Thirty-four (69.4%) of the patients presented with OSA; 22 had mild OSA, and 12 had moderate-to-severe OSA. APAP treatment was prescribed in 17 of the patients. After 1 month of therapy, all patients used APAP more than 70% of the nights for more than 4 h per night.ConclusionWe found a high prevalence of OSA among all of the patients with fibrotic DPLD (not only IPF). Despite certain difficulties, it was possible to achieve good APAP compliance in these patients.