Primary lung carcinoma metastatic to a solitary fibrous tumor.

We report the case of a 78-year-old man with a 2 month history of newly diagnosed metastatic lung adenocarcinoma, who presented with a left gluteal soft tissue mass. Histological examination of the mass revealed a solitary fibrous tumor containing metastases from adenocarcinoma.

Patellar metastasis from a squamous carcinoma of the lung: a case report.

Bone is a common site of metastasis from lung cancer. Metastasis to the patella, however, is rare. A 76-year-old man presented with knee pain caused by an isolated patellar metastasis from squamous cell carcinoma of the lung. Treatment was delayed secondary to delay in diagnosis. In cases of bone pain that are unexplained or out of proportion to a traumatic event, more extensive diagnostic studies should be done.

Interactive Atlas of Sign in Musculoskeletal Radiology

It presents images and information related to common and not so common signs used in Musculoskeletal Radiology, which can be reviewed by sign name (from Absent bow tie sign to Vacuum phenomenon), pathological diagnosis or locations (from Ankle to Wrist). The signs are illustrated with radiographs and diagrams. The references are linked to PubMed, allowing access to the abstract, if available.

Lipohemarthrosis

It describes the CT, MRI, and radiographic appearance of lipohemarthrosis of the elbow, hip, knee, and shoulder joints.

Soft tissue echinococcosis: a report of two cases and review of the literature.

Echinococcosis (hydatid cyst disease) is a zoonotic infection caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can implant in many organs of the body, most commonly the liver, and create internal budding cystic masses. Echinococcal cysts also can implant in soft tissues; however, a review of the literature revealed no published case with the patient initially presenting with a soft tissue mass. Two such cases are reported in the current study. Physicians who evaluate soft tissue masses, particularly in patients from Echinococcus-endemic areas, need to include echinococcosis in their differential diagnoses. The current treatment of choice for soft tissue echinococcosis is wide resection combined with perioperative medical therapy.

Imaging of surgical paraphernalia: what belongs in the patient and what does not.

Many radiologists are not familiar with the names of various instruments, surgical sponges, and needles that may be seen on intraoperative and postoperative radiographs. These devices may be intentionally placed for localization or therapeutic intervention, discovered on radiographs obtained to evaluate incorrect sponge or needle counts, or incidentally encountered on postoperative radiographs. These paraphernalia are usually described in vague nonspecific terms in radiology reports. In this article, photographs and radiographs of several instruments commonly used for intraoperative localization or therapy are presented, as well as examples of sponges, needles, and other devices that should not be found on postoperative radiographs. Familiarity with their appearances will allow a more precise and knowledgeable description in radiology reports.

Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial.

OBJECTIVE: To determine if visually-guided arthroscopic irrigation is an effective therapeutic intervention in patients with early knee osteoarthritis. DESIGN: Ninety patients with knee osteoarthritis were randomized in a double-blind fashion to receive either arthroscopic irrigation with 3000 ml of saline (treatment group) or the minimal amount of irrigation (250 ml) required to perform arthroscopy (placebo group). The primary outcome variable was aggregate WOMAC score. RESULTS: The study did not demonstrate an effect of irrigation on arthritis severity as measured by aggregate WOMAC scores, the primary outcome variable; the mean change in aggregate WOMAC score at 12 months was 15.5 (95% CI 7.7, 23.4) for the full irrigation group compared to 8.9 (95% CI 4.9, 13.0) for the minimal irrigation group (P=0.10). Full irrigation did have a statistically significant effect on patients' self-reported pain as measured by the WOMAC pain subscale and by a visual analog scale (VAS) (the secondary outcome variables). Mean change in WOMAC pain scores decreased by 4.2 (95% CI -0.9, 9.4) for the full irrigation group compared with a mean decrease of 2.3 (95% CI -0.1, 4.7) in the minimal irrigation group (P=0.04). Mean VAS pain scores decreased by 1.47 (95% CI -1.2, 4.1) in the full irrigation group compared to a mean decrease of 0.12 (95% CI 0.0, 0.3) in the minimal irrigation group (P=0.02). A hypothesis-generating post-hoc analysis of the effect of positively birefrigent intraarticular crystals showed that patients with and without intraarticular crystals had statistically significant improvements in pain assessments and aggregate WOMAC scores at 12 months; patients with crystals had statistically greater improvements in pain. CONCLUSIONS: Visually-guided arthroscopic irrigation may be a useful therapeutic option for relief of pain in a subset of patients with knee OA, particularly in those who have occult intraarticular crystals.

Bone mineral density increases with vitamin D repletion in patients with coexistent vitamin D insufficiency and primary hyperparathyroidism.

Two hundred and twenty-nine consecutive subjects, 202 women and 27 men, referred for evaluation of osteoporosis or low bone mineral density (BMD) had serum measurements of immunoreactive PTH (iPTH) and 25-hydroxyvitamin D (25OHD) performed. Fifteen individuals (mean age +/- SE, 75+/-2.4 yr) had depressed serum 25OHD (<15 pg/mL) and concomitantly elevated (>65 pg/mL) iPTH levels. After successful treatment of vitamin D insufficiency in all subjects, iPTH remained inappropriately high or frankly elevated in 5, describing a 2.2% prevalence rate of coexistent primary hyperparathyroidism and vitamin D insufficiency in our population. Despite persistent primary hyperparathyroidism, normalization of serum 25OHD levels in these 5 subjects increased their BMD at an annual rate of 6.3% and 8.2% in spine and hip, respectively. Our results suggest that coexistent vitamin D insufficiency can obscure the diagnosis of primary hyperparathyroidism and, when treated effectively, can result in substantial short-terms gains in BMD despite persistence of the inappropriate production of PTH.

Primary osteosarcoma of a metatarsal bone.

Although osteosarcoma is the most common primary bone malignancy of childhood and adolescence that is not related to marrow cells, involvement of the short tubular bones is uncommon. In contrast to more conventional sites, where the tumor is usually high grade and found in adolescents, osteosarcoma of the small bones is more likely to be low grade, and is often seen in older individuals. We present a case of low-grade primary osteosarcoma of a metatarsal bone in a 25-year-old woman.

Coccidioidomycosis fungal infection in the hand mimicking a metacarpal enchondroma.

Coccidioidomycosis, an infection caused by the fungus Coccidioides immitis, rarely affects the hand, but we report an unusual case which mimicked the radiological appearance of an enchondroma in the metacarpal. Curettage and bone grafting in combination with long-term antifungal therapy are necessary for successful treatment of coccidioidomycosis of the hand.

Atypical adult non-calcified pilomatricoma.

We present a rare case of a non-calcified pilomatricoma in a 67-year-old man. This tumor was extremely large in size, and its location, in the lower extremity, was very unusual. The clinical, radiographic, and histopathological features are described in detail. The role of magnetic resonance imaging (MRI) in the diagnosis of this entity is discussed. Definite internal reticulations and septations were observed. A possible explanation for this observation is that the high signal intensity reticulations may represent edematous stroma surrounding basaloid cells.

Primary musculoskeletal neoplasms: effectiveness of core-needle biopsy.

PURPOSE: To analyze the effectiveness of core-needle biopsy for evaluation of possible primary musculoskeletal neoplasms, which often are evaluated with open biopsy. MATERIALS AND METHODS: Core-needle biopsy was performed at a tertiary care institution in 141 patients suspected of having a mesenchymal neoplasm. In 85 patients, the lesion was in soft tissue; in 56 patients, the lesion was in bone. Eighty-nine patients had a malignant lesion, and 52 had a benign lesion. Twenty-eight patients had undergone previous surgery. RESULTS: In 105 (74%) patients, core-needle biopsy results were concordant with results from specimens subsequently obtained at surgery with respect to tumor histologic features and grade, or they provided sufficient diagnostic information to obviate surgery. In 36 (26%) patients, inaccurate core-needle biopsy results were obtained: In nine, results were imprecise about exact histologic features; in three, results were correct about histologic features but incorrect about tumor grade. In 25 (18%) patients, open biopsy was performed after core-needle biopsy. The accuracy and rate of performance of open biopsy for soft-tissue lesions were not significantly different from those for bone lesions. CONCLUSION: Percutaneous core-needle biopsy can be an effective alternative to open biopsy in the evaluation of possible mesenchymal neoplasms of either bone or soft tissue. Needle biopsy of such lesions, however, is best performed as part of a multidisciplinary team approach to tumor management.

Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging.

PURPOSE: To evaluate posteromedial tibial plateau injuries of or about the semimembranous tendon insertion site and their association with anterior cruciate ligament (ACL) tears on magnetic resonance (MR) images. MATERIALS AND METHODS: A retrospective study of MR images and conventional radiographs was performed in 10 patients with posteromedial tibial plateau injuries, including avulsion fractures of the semimembranous tendon insertion site. Associated abnormalities were analyzed, including ACL tears, medial meniscal tears, and other lateral femorotibial compartment injuries. Findings from the clinical history and physical examination were correlated with radiographic and MR imaging findings. Nine patients had arthroscopically or surgically documented ACL tears. RESULTS: All 10 patients had ACL tears at MR imaging. Five patients had posteromedial tibial plateau fractures: Four had avulsion fractures of the tendon insertion site, and one had a fracture lateral to the site. Five patients had posteromedial tibial plateau bruises: Two had bruises at the tendon insertion site. Five patients had tears of the posterior horn of the medial meniscus. Two patients had posterior meniscocapsular separations. Three patients showed evidence of the O'Donoghue triad. Six patients had bruises of the lateral tibial plateau and of the lateral femoral condyle. CONCLUSION: There appears to be an association between posteromedial tibial plateau injuries and ACL tears. Posteromedial tibial plateau injuries may be predictive of ACL status.

Magnetic resonance imaging in the evaluation of ligament injuries.

Magnetic resonance imaging has had a dramatic effect on the means by which we diagnose ligament injuries. Tears resulting from either acute trauma or overuse can be detected noninvasively, directing appropriate therapy be it conservative or surgical. For the elite athlete, earlier diagnosis leads to earlier intervention, or alternatively, a normal MRI examination can result in an earlier return to play. While MRI is accepted for the diagnosis of certain injuries such as complete tears of the cruciate ligaments of the knee, other injuries, such as partial cruciate ligament tears or tears of the intercarpal ligaments of the wrist, remain controversial.

Anterolateral impingement of the ankle: effectiveness of MR imaging.

PURPOSE: To determine the effectiveness of magnetic resonance (MR) imaging in the diagnosis of anterolateral impingement of the ankle. MATERIALS AND METHODS: MR images were reviewed in 12 patients (12 ankles) with arthroscopically proved anterolateral impingement and in 19 control subjects (20 ankles) with diagnoses other than impingement. MR images were scored by means of consensus of two musculoskeletal radiologists and independently by a third radiologist. Patients underwent imaging at 1.5 T, with use of standard imaging sequences and a dedicated extremity coil. RESULTS: For the consensus reading, the sensitivity, specificity, and accuracy of MR imaging for the diagnosis of impingement were 42%, 85%, and 69%, respectively. The frequency of lateral gutter fullness and anterior talofibular ligament thickening on MR images was higher in the 12 ankles with impingement (seven [58%] and seven [58%] ankles, respectively) than in the 20 control ankles (seven [35%] and five [25%] ankles, respectively), but these trends did not reach statistical significance. Interobserver agreement for anterior talofibular ligament thickening was high, whereas that for lateral gutter fullness was fair. CONCLUSION: Conventional MR imaging of the ankle is insensitive for anterolateral impingement. Anterior talofibular ligament thickening and soft-tissue fullness in the lateral gutter may be suggestive of the diagnosis, but the reliability of the latter finding is questionable.

Imaging sports injuries: the future.

OBJECTIVE: To review the application of new imaging technologies to the practice of sports medicine. DATA SYNTHESIS: Musculoskeletal imaging has dramatically evolved over the past decade. Plain film acquisition, archiving, storage, and interpretation have undergone revolutionary changes, moving into the electronic era. Viewing hard-copy film is becoming obsolete as digital image acquisition and display will eventually render radiology departments filmless. Although it seems unlikely that a new modality will enter the imaging arena in the near future, we will continue to see the development of software and hardware technology that allows rapid acquisition of superior quality cross-sectional image data. CONCLUSION: As these technologies continue to flourish, diagnosis and treatment planning of the injured athlete will become both more expedient and more accurate.

Stress injuries of bone: analysis of MR imaging staging criteria.

RATIONALE AND OBJECTIVES: The authors examined the prognostic value of magnetic resonance (MR) imaging in stress injuries of bone. MATERIALS AND METHODS: Clinical follow-up data were collected in 35 patients who underwent MR imaging because of suspected stress fractures. MR findings were correlated with total duration of symptoms, the time to return to sports activity, and findings at follow-up radiography. RESULTS: The MR imaging finding of a "fracture" or "fatigue" line or a cortical signal intensity abnormality was predictive of a longer symptomatic period, whereas muscle edema was predictive of a shorter symptomatic period. A published grading system could be used in only 24 patients; the MR imaging grade of injury did not show correlation with clinical outcome. CONCLUSION: The MR imaging finding of either a medullary line or a cortical abnormality appears to indicate a more severe stress injury of bone. A previously published MR imaging grading system for stress injuries of the tibia was not prognostic in this more heterogeneous patient group.

Surface lesions of bone.

A surface lesion of bone may arise within the cortex, between the cortex and the periosteum, within the periosteum, or in the tissues immediately adjacent to the periosteum including tendinous and ligamentous attachments. While these lesions generally reflect the spectrum of more common intramedullary lesions and have an appearance similar to that of their intramedullary counterparts, their unusual surface origin often renders diagnosis difficult. Surface sarcomas are usually of a lower grade than that of the intramedullary tumor, and often they have a more favorable prognosis. Traumatic lesions of the bone surface are common and should be considered in the differential diagnosis of a surface lesion, especially in the young or athletic individual. An elevated peripheral white blood cell count and erythrocyte sedimentation rate may herald an infection of the bone surface.