Modified technique for imaging the wrist and elbow in obese and claustrophobic patients using a non-open standard MRI scanner.

OBJECTIVE: It is challenging to image extremely obese and claustrophobic patients using a standard, non-open, magnetic resonance imaging (MRI) scanner. On the other hand, installing an additional upright or open MRI scanner may not be cost-effective for most practices. Our technique with a patient in a sitting or standing position behind the standard MRI scanner may be helpful in the MR examination of the wrist/elbow in these patients using a standard wrist/elbow coil. MATERIAL AND METHODS: We performed wrist and elbow MRI of extremely obese and claustrophobic patients by using our modified technique with the patient sitting or standing outside the standard non-open MRI scanner. A total number of 20 cases with the following diagnosis were examined: triquetral and scaphoid bone contusions and fractures, scapholunate ligament tears, triangular fibrocartilage complex tear, and biceps tear. RESULTS: Comparison of image quality for diagnostic information between the standard technique and our technique showed no significant difference, which is necessary for making the diagnosis. CONCLUSIONS: Our technique enables wrist and elbow imaging of extremely obese and claustrophobic patients who cannot otherwise be imaged using a standard MRI scanner without compromising the image quality that is essential for making a diagnosis.

Longitudinal Stress Fracture of the Femur: A Rare Entity.

Exercise-induced stress reactions and stress fractures are common causes of pain in athletes. Although most stress fractures are trans- verse in orientation, rarely longitudinal stress fractures may occur in the tibia and femur. Early detection is important to start prompt and appropriate treatment to prevent complications. Thus, familiarity with the clinical presentation, imaging findings, and treatment of this rare entity are important for proper and timely treatment.

Calf Muscle Herniation Presenting Twelve Month After Dog Bite Injuries: A Case Report.

Dog bites are the most common animal bite injuries in the US. One of the rare complications that can occur is muscle herniation, through a fascial defect created by the bite. It can be associated with pain and a palpable lump. We report a rare case of simultaneous tibialis anterior and soleus muscle hernias in a middle-aged man caused by dog bites in the calf 12 months prior to presentation. To the best of our knowledge, this clinical scenario has not been previously reported in the literature. Clinicians should be aware that a remote history of dog bites may be a clinically im- portant history to elicit in a patient presenting with pain and a palpable lump in the lower extremity.

Morel-Lavallée Lesion: A Case of an American Football Injury.

Morel-Lavallée Lesion (MLL) is a posttraumatic, closed degloving injury where the skin and superficial fascia get separated from deep fascia (fascialata) in the trochanteric region and upper thigh, hence creating a potential space. Similar lesions at other locations (e.g., abdominal wall and lumbar regions) have been described as Morel-Lavallée effusion, hematoma, or extravasation. Injury to an area with rich vascular and lymphatic supply leads to filling of this space with blood, lymph, fat, and necrotic debris. MLL usually presents as painful fluctuant swelling in the anterolateral portion o fthe upper thigh. Many of these maybe missed at initial evaluation and present weeks to months after the initial trauma.

A Case of Spontaneous Intracranial Hypotension: The Role of Dynamic CT Myelography and Epidural Blood Patch in Diagnosis and Treatment.

Spontaneous intracranial hypotension (SIH) most commonly results from cerebrospinal fluid (CSF) leaks in the upper spinal canal. Alterations in the equilibrium between the volumes of intracranial blood and CSF lead to compensatory dilatation of the vascular spaces, mostly on the venous side. Dynamic computerized tomogram (CT) myelography can be very helpful in diagnosing the site of a CSF leak in the spinal canal. Subsequently, the site of the leak can be sealed with epidural blood patch (EBP).

Chylous ascites in cirrhosis from retroperitoneal lymphoma.

Chylous ascites occurs due to processes that elevate pressures within or obstruct the lymphatics in the retroperitoneum. In cirrhosis, spontaneous chylous ascites can occur but is uncommon. We describe a case of a 74-year-old man with cirrhosis from nonalcoholic steatohepatitis who presented with worsening abdominal distension and chylous ascites on paracentesis; an infiltrating retroperitoneal lymphoma was subsequently detected on computed tomography imaging.

Retained Wooden Foreign Body in the Second Metatarsal.

The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, if at all. Although plain radiography is known to be ineffective for demonstrating radiolucent foreign bodies, it is often the first imaging modality used. In such cases, complete surgical extraction cannot be guaranteed, and other imaging modalities should be considered. We present a case of a retained toothpick of the second metatarsal in a young male patient who presented with pain in the right foot of a few weeks' duration. Plain radiography showed an oval cyst at the base of the second metatarsal of the right foot. Magnetic resonance imaging revealed a toothpick penetrating the second metatarsal. The patient recalled stepping on a toothpick 8 years previously. Surgical exploration revealed a 2-cm toothpick embedded inside the second metatarsal.

MRI illustration of traumatic lipohemarthrosis of the wrist joint due to a scaphoid fracture.

Traumatic lipohemarthrosis of the wrist joint in association with a scaphoid fracture is an unreported entity. We present the first case report of MRI appearance of a double fluid-fluid level of lipohemarthrosis caused by a scaphoid fracture. The presence of a double fluid-fluid level within the injured joint definitely establishes a lipohemarthrosis. A traumatic lipohemarthrosis is considered synonymous with an intra-articular fracture and has important implications for patient management. A limited MRI scan for diagnosis or exclusion of scaphoid fracture may be more cost-effective than expectant management and subsequent followup visits.