[Stress fracture or osteochondral lesion of the navicular bone?] / Stressfractuur of osteochondraal letsel van het os naviculare?

BACKGROUND: An osteochondral lesion of the navicular bone in the foot is rare. Differentiation from a stress fracture is difficult, since both lesions usually present as vague pain in the midfoot in active young adults. However, the typical location differs. SPECT-CT allows an etiological diagnosis to be made. As management differs for the two lesions, a correct diagnosis is important. CASE DESCRIPTION: A 19-year-old male athlete had pain in the dorsal right midfoot on weight-bearing. A diagnosis of 'stress fracture of the navicular bone' was made on the basis of SPECT-CT. Since conservative therapy did not help, and because the location was atypical for a stress fracture, the diagnosis was revised to 'osteochondral lesion'. CONCLUSION: The key to the diagnosis of osteochondral lesion is its location in the central proximal third of the navicular bone. Patients with this type of lesion often undergo surgical treatment, whereas conservative therapy is sufficient in case of a stress fracture.

Popliteal Arteriovenous Fistula Following Total Knee Arthroplasty.

Postoperative popliteal arteriovenous fistula is a very rare complication. We report a unique asymptomatic fistula in a 77-year-old male patient, seven months after total knee replacement. The diagnosis was suspected by a clinical palpable thrill and confirmed with a typical doppler ultrasound signaling. This vascular malformation was successfully treated by surgical resection of the fistula. Referring to the literature, considering the management of popliteal aneurysms, we suggest to prefer an open procedure in patients who are in good general condition.

ISCHIOFEMORAL IMPINGEMENT DUE TO A SOLITARY EXOSTOSIS.

Ischiofemoral impingement is a rare cause of hip pain related to narrowing of the space between the ischial tuberosity and the lesser trochanter. It is usually seen in middle-aged women. We report a rare case of a young male patient presenting with ischiofemoral impingement due to a solitary exostosis at the lesser trochanter. Imaging, especially Magnetic Resonance Imaging (MRI), is an excellent tool to confirm the diagnosis by demonstrating narrowing of the ischiofemoral space and soft tissue edema in the muscle belly of the quadratus femoris muscle.

Imaging of the spleen: what the clinician needs to know.

The spleen is considered 'the forgotten organ' among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.

Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma.

OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma. MATERIALS AND METHODS: Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared. RESULTS: Fracture detection on CBCT increased by 35% and 37% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236% and 185%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT. CONCLUSION: CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

Traumatic lesions of the distal radio-ulnar joint (DRUJ) occur frequently in conjunction with fractures of the distal radius. They are a common cause of pain and limited range of motion after distal radial fractures. Due to the complex anatomy they are however often ignored or underappreciated. Distal radial fractures and luxations of the DRUJ often disturb the normal curvature of the radial notch and cause damage to the cartilage of this joint. The growth of the radius may be disrupted, resulting in a positive ulnar variance, and possibly give rise to complications such as ulnar abutment and motion restriction. Ulnar styloid fractures - sometimes barely visible on plain film - may give rise to symptomatic bony pseudarthrosis, dislocation and laceration of the tendon of the m. extensor carpi ulnaris and a rare posttraumatic deformity of the ulnar epiphysis. Also the possibility of lesions at the adjacent triangular fibrocartilage complex and the joint capsule should be kept in mind. This paper presents a pictorial review of the complex functional anatomy and pathologic conditions of this joint and emphasises why the DRUJ should be evaluated independently and thoroughly. The merit of each imaging modality is mentioned. A correction article relating to Fig. 2 and Fig. 27 can be found here: http://dx.doi.org/10.5334/jbr-btr.966.

Correction: Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

This article details a correction to: Mespreuve, M, Vanhoenacker, F and Verstraete, K 2015 Imaging Findings of the Distal Radio-Ulnar Joint in Trauma. Journal of the Belgian Society of Radiology, 99(1), pp. 1-20, DOI: http://dx.doi.org/10.5334/jbr-btr.846.

Hepatosplenic Sarcoidosis Complicated by Liver Cirrhosis.

Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. Other organs, such as the liver and the spleen, are less commonly involved. Patients usually present with mild nonspecific symptoms. On imaging, hepatosplenomegaly with or without multiple focal lesions within the spleen may be seen in the active disease stage. Rarely, the disease may evolve to cirrhosis and liver failure. We report such a rare case of hepatosplenic sarcoidosis complicated by acute esophageal bleeding due to portal hypertension.

Plantar Vein Thrombosis: An Unusual Cause of Plantar Pain.

We present a case of an 80-year-old man with progressive pain for 5 days at the medial and plantar aspect of the left heel. Wearing shoes aggravated the pain. Ultrasound and magnetic resonance imaging (MRI) revealed thrombosis of the medial plantar veins. Plantar vein thrombosis is a rare condition. The clinical symptoms are non-specific and can be confused with plantar fasciitis. It has been associated with hypercoagulable conditions, foot trauma and recent surgery. The imaging modality of choice is ultrasound. MRI may add to the diagnosis in unclear cases.

Post-traumatic osteoid osteoma in an 18-year-old adolescent.

Osteoid osteoma (OO) is a painful, benign bone-forming lesion, which often poses a diagnostic challenge. The aetiology of OO is still poorly understood. Although not generally accepted, an association with previous trauma or infection has occasionally been suggested. We present a case of an OO 12 years following an ulnar fracture. Radiologists should consider OO as a potential delayed "complication" of a previous fracture. Persistent pain at a previous fracture site should alert the clinician to request cross-sectional imaging. CT scanning plays a pivotal role in the correct diagnosis of OO.

Intra-articular synovial lipoma of the knee joint.

We present a rare case of an intra-articular synovial lipoma, which was diagnosed in a patient after a knee trauma. MRI is the imaging modality of choice to suggest the diagnosis preoperatively, by demonstrating a well-delineated fat-containing lesion. The differential diagnosis of an intra-articular lipomatous lesion consists of lipoma arborescens and synovial lipoma.

Lunotriquetral coalition, a normal variant that may rarely cause ulnar sided wrist pain.

Lunotriquetral coalition (LTC), the most frequent and often bilateral type of carpal coalition, is in general considered as asymptomatic. In rare cases - however - fibrocartilaginous LTC may be an uncommon cause of ulnar sided pain in the wrist due to the pseudarthrosis or a post-traumatic disruption of LTC. Two rare cases of symptomatic LTC are presented and the role of MRI is emphasized. MRI shows the pseudarthrosis and may additionally show bone marrow edema and subcortical cysts. In symptomatic cases surgical lunotriquetral fusion may be considered as treatment option.

Stafne Bone Cavity.

BACKGROUND: A 53-year-old male was referred to the department of maxillofacial surgery for the extraction of a destructed wisdom tooth. A preoperative orthopantomogram revealed a well delineated ovoid, radiolucent lesion at the left angle of the mandible. For further lesion characterization, a dental CT scan and MRI were performed.