RESUMO
OBJECTIVE: The objective of this study was to describe the anatomy and MR appearance of the spring ligament recess of the talocalcaneonavicular joint. SUBJECTS AND METHODS: Forty-nine MR examinations of the ankle with a spring ligament recess were prospectively collected. The size of the recess was measured. The presence of the following variables was recorded: talocalcaneonavicular joint effusion, ankle joint effusion, talar head impaction, acute lateral ankle sprain, chronic lateral ankle sprain, spring ligament tear, sinus tarsi ligament tear, talar dome osteochondral injury, and talonavicular osteoarthrosis. The Fisher exact test was performed to quantify the association of the talocalcaneonavicular effusion with the other variables. MR arthrography and dissection with histologic analysis were performed in two cadaveric ankles. RESULTS: Twenty-four men and 25 women (average age, 39 years; range, 21-77 years) were included in the study. The average size of the fluid collection was 0.4 × 0.8 cm (range, 0.2-0.9 × 0.4-1.5 cm). The prevalence of the measured variables was talocalcaneonavicular joint effusion, 67.3%; ankle joint effusion, 61.2%; talar head impaction, 32.7%; acute lateral ankle sprain, 28.6%; chronic lateral ankle sprain, 59.2%; spring ligament tear, 14.3%; sinus tarsi ligament tear, 12.2%; talar dome osteochondral lesion, 20.4%; and talonavicular osteoarthrosis, 18.4%. There was a higher prevalence of talar head impaction among individuals with talocalcaneonavicular joint effusion (p = 0.0522). Cadaveric study revealed communication between the talocalcaneonavicular joint and the spring ligament recess. CONCLUSION: The spring ligament recess is a synovium-lined, fluid-filled space that communicates with the talocalcaneonavicular joint. The recess should be distinguished from a tear of the plantar components of the spring ligament.
Assuntos
Articulação do Tornozelo , Artropatias/diagnóstico por imagem , Artropatias/patologia , Ligamentos Articulares/patologia , Imageamento por Ressonância Magnética , Articulações Tarsianas , Adulto , Idoso , Artrografia , Cadáver , Estudos de Coortes , Dissecação , Feminino , Humanos , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Neoplasias Femorais/diagnóstico , Osteossarcoma/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Neoplasias Femorais/cirurgia , Humanos , Imageamento por Ressonância Magnética , Gradação de Tumores , Osteossarcoma/cirurgia , Osteotomia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Cistos/diagnóstico , Obstrução Nasal/etiologia , Ducto Nasolacrimal , Cistos/congênito , Endoscopia , Humanos , Recém-Nascido , MasculinoRESUMO
BACKGROUND: To our knowledge, the sensitivity of plain radiography, known as the shunt series, in diagnosing an etiology of ventriculoperitoneal (VP) shunt malfunction in children has not been previously investigated. OBJECTIVE: To determine the accuracy of plain radiography in diagnosing VP shunt failure in children in whom shunt malfunction is clinically suspected. MATERIALS AND METHODS: We retrospectively reviewed the charts of 238 children who had undergone plain radiographic examination for evaluation of clinically suspected VP shunt failure over a 5-year period. The results were compared with those of CT, MRI, and nuclear cisternography. RESULTS: Just 6.72% of patients demonstrated plain radiographic signs of shunt failure. Of patients with normal plain radiographs, 43% demonstrated shunt abnormalities on CT, MRI or cisternography. Statistical analysis indicated that no more than 10.46% (P < 0.05) of plain radiographs showed signs of failure and that the sensitivity of plain radiography for the detection of VP shunt failure is no higher than 31%. Furthermore, there was poor agreement between the results of plain radiography and those of CT, MRI and cisternography. CONCLUSION: Children with clinically suspected VP shunt failure should proceed directly to cross-sectional or nuclear imaging, as plain radiographic examinations have low sensitivity and significant false-negative rates for detecting shunt abnormalities in all-comers. Use of the shunt series should be limited to patients who specifically have suspected mechanical causes of shunt failure.