The proximity of the lateral calcaneal artery (LCA) to surgical incisions applied to the lateral hindfoot makes it vulnerable to iatrogenic injury and subsequent postoperative skin necrosis. This study aimed to investigate the course of the LCA and to define anatomical points that can be used by surgeons during lateral approaches to the calcaneus. Thirteen leg-ankle-foot specimens were dissected and the superficial course of the LCA was outlined by three anatomic points: (a) tip of lateral malleolus, (b) the point where it pierces the deep fascia, and (c) the point where it crosses the line connecting the lateral malleolus with the insertion of Achilles tendon. Fifteen healthy volunteers were investigated by color Doppler ultrasound where the diameter and depth of LCA were measured. The LCA pierced the deep fascia at a maximum height of 4.5 cm (mean 3.78) above the midpoint of a line extending from the lateral malleolus to the insertion of Achilles tendon. It crossed the previous line at a maximum distance of 3 cm (mean 2.6) posterior to lateral malleolus. At this point, its mean diameter was 1.75 mm on the right and 1.73 mm on the left sides, while its mean depth was 7.73 mm on the right and 8.0 mm on the left sides. A dangerous triangle that contained the superficial course of the artery was mapped out in the lower lateral part of the leg. This triangle should be considered during surgical approaches applied to the lateral hindfoot to avoid damage of the LCA.
Background: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the examination of decision for renal colic when compared to ultrasonography; be that as it may, radiation presentation can be a worry. Aim of Study: Comparison between low dose CT and ultrasound in diagnosis of renal and uretral stones in adults.Conclusion: Low dose CT shows up as preferred imaging modality for uorolithiasis over ultrasound because of its high sensitivity and accuracy in identifying renal and ureteral stones.
Background: Magnetic resonance imaging (MRI) is the technique that demonstrated the highest sensitivity and specificity in the early diagnosis of osteonecrosis. It allows detecting initial typical signal intensity alterations of the bone marrow when other examinations showed nonspecific findings or even no alterations at all. The aim of this study is to assess the role of magnetic resonance imaging in detection and monitoring osteonecrotic lesions in pediatric patient with acute lymphoblastic leukemia after chemotherapy. Materials and Methods: This prospective study was performed on 30 pediatric patients ranged from 4 to 18 years with acute lymphoblastic leukemia on chemotherapy or after 3months from ending chemotherapy with symptoms suspicious for osteonecrosis (i.e., articular pain). All patients were explained about the procedure to be done. MRI study of whole lower limbs was done for all patients. Results: In the present study all patients were symptomatic. 24\30 patients (80%) had hip pain, 25\30 patients (83.3%) had knee pain and 8\30 patients (26.7%) had limping. We reported that knee pain was the most common complaint representing 83.3% of patients. 11\30 patients (36.7%) had no MRI findings. 19\30 patients (63.3%) had different positive findings; 4 patients (13.3%) had non -articular osteonecrosis (ON) only with no joint involvement (bone infarction), 2 patients (6.7%) had avascular necrosis of femoral head epiphysis without bone infarction and 13 patients (43.3%) had combined bone infarction and avascular necrosis with Joint involvement. Follow up by MRI was done for all patients (30 patients), 27 patients showed no change in MRI findings, one patient progressed from avascular necrosis of the femoral head epiphysis without deformity to avascular necrosis of the femoral head epiphysis with deformity. The other two patient showed regressive course. Conclusion: We concluded that MRI study is mandatory for early detection and monitoring of lower limb osteonecrosis in pediatric patients with acute lymphoblastic leukemia under or after chemotherapy. The radiologist and clinician must do MRI lower limbs routinely and follow up MRI after 4-6 months to first MRI due to some patients had regressive or progressive findings.
Background: Ankle impingement is the painful mechanical restriction of complete ankle range of motion caused by an osseous or soft-tissue deformity. Ankle impingement syndromes are prevalent and significant post-traumatic sources of morbidity in professional and amateur sports. The aim of this research is to evaluate the role of Magnetic Resonance Imaging (MRI) in diagnosis of ankle impingement syndromes. Methods: This prospective study was performed on 40 consecutive patients aged from 20 to 55 years old, with clinical diagnosis of ankle impingement, 21 (52.5%) of them were males and 19 (47.5%) were females. All patients were subjected to full history taking [personal history, history of present illness (onset, course and duration; pain, swelling, limitation of movement, and other symptoms)], clinical Examination was carried out by the colleagues in the Orthopaedic department and MRI examination where all patients were examined with closed superconductive 1.5 T magnet (GE SIGNA Explorer), using the extremity coils. Results: 26 out of the 28 cases with clinically suspected posterior impingement were correctly diagnosed by MRI (sensitivity of 92.86%, specificity of 100% and accuracy of 92.86%) and other two cases showed synovial effusion. 3 out of the 4 cases with clinically suspected anterolateral impingement were correctly diagnosed by MRI (sensitivity of 75%, specificity of 100% and accuracy of 75%) and other case showed sinus tarsi. All the 4 cases with clinically suspected anterior, anterolateral impingement were correctly diagnosed by MRI (sensitivity of 100%, specificity of 100% and accuracy of 100%). Totally, MRI sensitivity in diagnosis impingement was 92.5%, specificity was 100% and accuracy was 92.5%). Conclusions: MRI exhibits excellent overall sensitivity, specificity, and accuracy in the diagnosis of ankle impingement. MRI displays rather definite anatomic and pathologic details, with outstanding outlining of both bony and soft tissue structures. Moreover, it assists in the exclusion of other mimic similar conditions.
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