Acute ankle injuries: association between sprain severity and ancillary findings.

Miranda et al. reported a correlation between the significance of injuries to osseous, chondral, tendon, and ligamentous tissues in participants with low-grade versus high-grade acute ankle sprains. They demonstrated that participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of structural abnormalities compared to those with low-grade sprains. Special attention should be paid to acute ankle sprains in emergency settings to avoid failure in detecting severe injuries that could lead to chronic pain, impairment, or instability. Participants presenting acute ankle sprains (<15 days) were divided into low-grade versus high-grade sprain,according to the presence of a complete tear in at least one component of lateral ligament complex. High-grade ankle sprains group presented increased rates of medial malleolus bone bruise, deltoid ligament tears,extensor retinaculum lesions, and articular effusion. The calcaneonavicular distance was statistically shorter in patients with high-grade sprains (median, 3.0mm) when compared to those with low-grade sprains (median, 4.0mm) Objective: To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. METHODS: We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. RESULTS: The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). CONCLUSION: Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study

Abstract Introduction Magnetic resonance imaging (MRI) T2* technique is used to assess iron overload in the heart, liver and pancreas of thalassaemic patients. Optimal iron chelation and expected tissue iron response rates remain under investigation. The objective of this study was to analyse serum ferritin and the iron concentration in the heart, liver and pancreas measured by MRI T2*/R2* during regular chelation therapy in a real-world cohort of patients with thalassemia. Methods We evaluated thalassaemic patients ≥ 7 years old undergoing chelation/transfusion therapy by MRI and assessed serum ferritin at baseline and follow-up from 2004-2011. Results We evaluated 136 patients, 92% major thalassaemic, with a median age of 18 years, and median baseline ferritin 2.033ng/ml (range: 59-14,123). Iron overload distribution was: liver (99%), pancreas (74%) and heart (36%). After a median of 1.2 years of follow-up, the iron overload in the myocardium reduced from 2,63 Fe mg/g to 2,05 (p 0.003). The optimal R2* pancreas cut-off was 148 Hertz, achieving 78% sensitivity and 73% specificity. However, when combining the R2* pancreas cut off ≤ 50 Hertz and a ferritin ≤ 1222 ng/ml, we could reach a negative predictive value (NPV) of 98% for cardiac siderosis. Only 28% were undergoing combined chelation at baseline assessment, which increased up to 50% on follow up evaluation. Conclusions Chelation therapy significantly reduced cardiac siderosis in thalassaemic patients. In patients with moderate/severe liver iron concentration undergoing chelation therapy, ferritin levels and myocardium iron improved earlier than the liver siderosis.

Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study.

INTRODUCTION: Magnetic resonance imaging (MRI) T2* technique is used to assess iron overload in the heart, liver and pancreas of thalassaemic patients. Optimal iron chelation and expected tissue iron response rates remain under investigation. The objective of this study was to analyse serum ferritin and the iron concentration in the heart, liver and pancreas measured by MRI T2*/R2* during regular chelation therapy in a real-world cohort of patients with thalassemia. METHODS: We evaluated thalassaemic patients ≥ 7 years old undergoing chelation/transfusion therapy by MRI and assessed serum ferritin at baseline and follow-up from 2004-2011. RESULTS: We evaluated 136 patients, 92% major thalassaemic, with a median age of 18 years, and median baseline ferritin 2.033ng/ml (range: 59-14,123). Iron overload distribution was: liver (99%), pancreas (74%) and heart (36%). After a median of 1.2 years of follow-up, the iron overload in the myocardium reduced from 2,63 Fe mg/g to 2,05 (p 0.003). The optimal R2* pancreas cut-off was 148 Hertz, achieving 78% sensitivity and 73% specificity. However, when combining the R2* pancreas cut off ≤ 50 Hertz and a ferritin ≤ 1222 ng/ml, we could reach a negative predictive value (NPV) of 98% for cardiac siderosis. Only 28% were undergoing combined chelation at baseline assessment, which increased up to 50% on follow up evaluation. CONCLUSIONS: Chelation therapy significantly reduced cardiac siderosis in thalassaemic patients. In patients with moderate/severe liver iron concentration undergoing chelation therapy, ferritin levels and myocardium iron improved earlier than the liver siderosis.

Acute ankle injuries: association between sprain severity and ancillary findings

ABSTRACT Objective To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. Methods We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. Results The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). Conclusion Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Incidence of adhesive capsulitis of the shoulder during the beginning of the COVID-19 pandemic

ABSTRACT Objective Adhesive capsulitis is an inflammatory disease of the joint capsule, clinically manifested as pain, stiffness, and dysfunction of the shoulder. We subjectively observed an increased incidence of adhesive capsulitis, and raised the hypothesis that adhesive capsulitis was more frequent in magnetic resonance imaging examinations performed during the COVID-19 pandemic as compared with examinations prior to this period. Methods Data from medical records and magnetic resonance imaging of the shoulder presenting typical imaging findings of adhesive capsulitis, performed in our organization from March to June 2020, were evaluated and compared with data and imaging from the same period of the previous year. To this end, an organizational business intelligence tool called "search reports" was used, searching for the term "adhesive capsulitis" in the radiological report, results were tabulated, and corresponding magnetic resonance imaging exams were analyzed. Results Our search found a total of 240 and 1,373 cases of adhesive capsulitis in the 2020 and 2019 periods, respectively. The mean age of patients was 53.9 years in the 2020 group and 49.9 years in 2019 (p<0.001). Magnetic resonance imaging findings were positive for adhesive capsulitis in 40 out of 240 shoulders (16.7%) in the 2020 group versus 127 out of 1,373 shoulders (9.2%) in the 2019 group. This difference was statistically significant (p=0.001). Conclusion Our study findings suggest a relative increase in the proportion of magnetic resonance imaging findings suggestive of adhesive capsulitis cases during COVID-19 pandemics based on data from our organization.

Main complications of hip arthroplasty: pictorial essay / Principais complicações da artroplastia de quadril: ensaio iconográfico

Abstract Hip arthroplasty is a widely used and successful orthopedic procedure for the treatment of degenerative, inflammatory, or traumatic joint disease. The procedure promotes significant pain relief, as well as recovery of limb function, reduction of disability, and better quality of life. However, there are related complications, which have characteristic imaging aspects. In the present study, we review the literature and exemplify such complications using images obtained at our facility, illustrating the main radiological aspects of complications such as heterotopic ossification, periprosthetic fractures, osteolysis, infection, wear, and dislocation.

Resumo A artroplastia de quadril é um procedimento cirúrgico ortopédico amplamente utilizado e de grande sucesso para tratamento da doença articular, seja esta degenerativa, inflamatória ou traumática, promovendo importante melhora da dor, recuperação da função do membro, redução da incapacidade e melhora da qualidade de vida. Entretanto, existem complicações relacionadas, as quais possuem aspectos de imagem característicos. O presente estudo revisou a literatura e exemplificou essas complicações de forma ilustrativa com a experiência do nosso serviço, abordando os principais aspectos radiológicos das complicações da artroplastia de quadril, englobando ossificação heterotópica, fraturas periprotéticas, osteólise, infecção, desgaste e luxação.

Snapping scapula syndrome: pictorial essay.

Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.

A síndrome da escápula em ressalto manifesta-se como uma crepitação audível ou palpável durante os movimentos de deslizamento da escápula sobre o gradil costal. Frequentemente percebida em atividades físicas ou profissionais, as suas causas podem ter origem na alteração morfológica da escápula e gradil costal, no desequilíbrio de forças da musculatura periescapular (discinesia) ou ainda em tumores ósseos ou de partes moles. O presente estudo revisou de forma ilustrativa as principais causas da síndrome da escápula em ressalto, exemplificadas por meio de uma coletânea de casos didáticos.

Snapping scapula syndrome: pictorial essay / Síndrome da escápula em ressalto: ensaio iconográfico

Abstract Snapping scapula syndrome manifests as an audible or palpable crackling during the sliding movements of the scapula over the rib cage, often perceived during physical or professional activities. It can be caused by morphological alteration of the scapula and rib cage, by an imbalance in periscapular musculature forces (dyskinesia), or by neoplasia (bone tumors or soft tissue tumors). In this pictorial essay, we review the main causes of snapping scapula syndrome, exemplified by a collection of didactic cases.

Resumo A síndrome da escápula em ressalto manifesta-se como uma crepitação audível ou palpável durante os movimentos de deslizamento da escápula sobre o gradil costal. Frequentemente percebida em atividades físicas ou profissionais, as suas causas podem ter origem na alteração morfológica da escápula e gradil costal, no desequilíbrio de forças da musculatura periescapular (discinesia) ou ainda em tumores ósseos ou de partes moles. O presente estudo revisou de forma ilustrativa as principais causas da síndrome da escápula em ressalto, exemplificadas por meio de uma coletânea de casos didáticos.

Avascular necrosis: radiological findings and main sites of involvement - pictorial essay / Necroses avasculares: achados radiológicos e principais sítios de acometimento - ensaio iconográfico

Abstract The term avascular necrosis describes any one of a number of bone diseases that have a common mechanism: the death of bone components due to lack of blood supply. Avascular necrosis can occur in diverse parts of the skeleton, each location-specific form not only receiving a distinct designation but also presenting unique epidemiologic characteristics. However, the imaging findings are similar in all of the forms, which pass through well-described radiological phases, regardless of the site of involvement. Because avascular necrosis can cause considerable morbidity if not properly detected and managed, the radiologist plays a fundamental role. The present study provides a brief review of the main radiological aspects of the various forms of avascular necrosis, illustrated on the basis of a collection of cases from our institution.

Resumo Necroses avasculares são um grupo de doenças ósseas que possuem como via comum a morte dos constituintes dos ossos por falta de suprimento vascular. Podem ocorrer nas mais diversas partes do esqueleto, recebendo não somente denominações distintas, como também apresentam epidemiologia única em cada uma dessas localizações. Seus achados nos métodos de imagem, no entanto, são similares, independente do seu sítio de acometimento, passando por fases radiológicas já bem descritas. Se não forem detectadas e manejadas de forma adequada, podem trazer grande morbidade aos pacientes, o que torna o papel do radiologista primordial. O presente estudo faz uma revisão sucinta acerca dos principais aspectos radiológicos das diversas formas de apresentação das necroses avasculares, ilustradas com base em uma coletânea de casos da nossa instituição.

Musculoskeletal "don't touch" lesions: pictorial essay.

Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.

O achado de lesões ósseas focais não é incomum no dia-a-dia do radiologista. É, portanto, imprescindível saber discernir as lesões com potencial maligno agressivo, que requerem ação, das desprovidas de significado clínico, muitas destas sendo variantes da normalidade ou processos reativos benignos, às vezes, autolimitados. Em alguns casos, a confusão diagnóstica pode ter resultados catastróficos, como a realização de biópsia em casos de miosite ossificante, que pode levar ao diagnóstico incorreto de lesões de origem sarcomatosa e a cirurgias mutilantes. O presente estudo faz uma revisão dos principais aspectos radiológicos das lesões que mais comumente são vistas no dia-a-dia e que possuem potencial para causar confusão com processos ósseos malignos e agressivos. Ilustramos, ainda, essas lesões, apresentando casos do nosso serviço.

Musculoskeletal "don't touch" lesions: pictorial essay / Lesões musculoesqueléticas do tipo "não toque": ensaio iconográfico

Abstract Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.

Resumo O achado de lesões ósseas focais não é incomum no dia-a-dia do radiologista. É, portanto, imprescindível saber discernir as lesões com potencial maligno agressivo, que requerem ação, das desprovidas de significado clínico, muitas destas sendo variantes da normalidade ou processos reativos benignos, às vezes, autolimitados. Em alguns casos, a confusão diagnóstica pode ter resultados catastróficos, como a realização de biópsia em casos de miosite ossificante, que pode levar ao diagnóstico incorreto de lesões de origem sarcomatosa e a cirurgias mutilantes. O presente estudo faz uma revisão dos principais aspectos radiológicos das lesões que mais comumente são vistas no dia-a-dia e que possuem potencial para causar confusão com processos ósseos malignos e agressivos. Ilustramos, ainda, essas lesões, apresentando casos do nosso serviço.

Ultrasonography and magnetic resonance imaging of elbow ligaments: a comparative study / Ultrassonografia na avaliação de ligamentos de cotovelo: estudo comparativo com imagem de ressonância magnética

ABSTRACT Objective: To determine the value of ultrasonography in elbow ligament assessment compared to magnetic resonance imaging. Methods: A prospective single-center study involving 30 volunteers with no elbow joint changes. Two experienced ultrasound specialists evaluated both elbows of each volunteer, resulting in 60 evaluations per physician and totaling up 120 evaluations. Magnetic resonance images were obtained using a 3-Tesla machine and evaluated by two experienced radiologists, totaling up 120 exams. Each examiner assigned subjective, zero-to-5 scores to ligaments imaged, where zero corresponded to non-identified ligament and 5 to visualization of the entire ligament. The level of significance was set at 5%. Bland-Altman dispersions and plots were prepared for each pair of measurements obtained. Results: All ligaments were amenable to sonographic identification; scores of 4 or 5 were assigned by examiners based on ligament visibility. Ligaments could also be identified using magnetic resonance imaging and were assigned scores of 5 by examiners. All ligaments were described as intact and healthy by all four examiners. Comparative analysis of elbow ligament sonographic and magnetic resonance imaging findings did not differ significantly. Conclusion: Ultrasonography and magnetic resonance imaging can be considered equivalent modalities for elbow ligament assessment in the hands of experienced examiners.

RESUMO Objetivo: Avaliar o desempenho da ultrassonografia na avaliação dos ligamentos do cotovelo, comparando os achados com ressonância magnética. Métodos: Estudo prospectivo unicêntrico envolvendo 30 pacientes, sem alterações articulares nos cotovelos. Dois ultrassonografistas experientes avaliaram ambos os cotovelos de cada um dos pacientes, com 60 avaliações cada médico e 120 avaliações no total. As imagens de ressonância magnética foram obtidas em aparelhos 3 Tesla. Dois radiologistas experientes avaliaram as imagens, com total de 120 exames. Cada examinador deu uma nota subjetiva, de zero a 5, para os ligamentos avaliados; zero correspondeu a ligamento não identificado, e 5 a ligamento visualizado integralmente. Foi considerado nível de significância de 5%. Para cada par de medidas obtidas, construíram-se dispersões e parcelas de Bland-Altman. Resultados: Todos os ligamentos foram identificados pelos examinadores de ultrassonografia, recebendo pontuação 4 ou 5, em relação à sua visibilidade, e foram identificados pelos examinadores de ressonância magnética, com pontuação 5. Foram considerados intactos e saudáveis pelos quatro examinadores. As comparações entre ultrassonografia e ressonância magnética na avaliação dos ligamentos do cotovelo não demostraram diferenças significativas. Conclusão: Quando realizada por examinadores experientes, a ultrassonografia pode ser considerada semelhante à ressonância magnética na avaliação de ligamentos do cotovelo.

Interobserver reproducibility of radiographic evaluation of lumbar spine instability / Reprodutibilidade interobservadores da avaliação radiográfica de instabilidade em coluna lombar

ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

RESUMO Objetivo: Mensurar a reprodutibilidade interobservadores da avaliação radiográfica da instabilidade da coluna lombar. Métodos: Foram realizadas mensurações das radiografias dinâmicas de coluna lombar na incidência em perfil, avaliando-se a translação anterior e a angulação entre os corpos vertebrais. Os exames foram avaliados em workstations da própria instituição, por meio do sistema Vue RIS (PACS) da Carestream Health, versão 11.0.12.14 Inc. 2009©. Resultados: A proporção de concordância em detecção de casos de instabilidade radiográfica entre os observadores variou de 88,1 a 94,4%, e os coeficientes de concordância AC1 estiveram todos acima de 0,8, indicando concordância excelente. Conclusão: A análise interobservadores realizada entre médicos ortopedistas com diferentes níveis de treinamento em radiografias dinâmicas da coluna vertebral obteve elevada reprodutibilidade e concordância. No entanto, alguns fatores, como método manual de aferição e a presença de osteófitos vertebrais, podem ter gerado alguns resultados menos consistentes nessa avaliação comparativa de medidas.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report / O cisto sinovial hemorrágico lombar pode causar compressão radicular aguda? Relato de caso

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report.

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Multiple myeloma complicated with pseudomonas endocartiditis / Mieloma múltiplo complicado com endocardite infecciosa por pseudomonas

Patients diagnosed with multiple myeloma are more susceptible to infections which are the major causes of morbidity and mortality associated to this disease. The main infectious agents involved are Gram-positive bacteria. However, after chemotherapy an increase in the incidence of Gram-negative strains is observed. These bacteria are also responsible for most cases of urinary tract infections. Here is reported a rare case in a 73-year-old man with multiple myeloma who developed endocarditis due to pseudomonas.

Pacientes diagnosticados com mieloma múltiplo são mais suscetíveis a infecções, que é a principal causa de morbidade e mortalidade associadas a essa doença. Os principais agentes infecciosos envolvidos são as bactérias Gram-positivas, mas, após a quimioterapia, pode haver aumento na incidência de Gram-negativos, que são responsáveis, na maioria dos casos, por infecções do trato urinário. Assim, descrevese um raro caso de um paciente de 73 anos de idade, com mieloma múltiplo diagnosticado com endocardite por pseudomonas.

Pancreatic iron stores assessed by magnetic resonance imaging (MRI) in beta thalassemic patients.

PURPOSE: To assess the correlation between MRI findings of the pancreas with those of the heart and liver in patients with beta thalassemia; to compare the pancreas T2* MRI results with glucose and ferritin levels and labile plasma iron (LPI). MATERIALS AND METHODS: We retrospectively evaluated chronically transfused patients, testing glucose with enzymatic tests, serum ferritin with chemiluminescence, LPI with cellular fluorescence, and T2* MRI to assess iron content in the heart, liver, and pancreas. MRI results were compared with one another and with serum glucose, ferritin, and LPI. Liver iron concentration (LIC) was determined in 11 patients' liver biopsies by atomic absorption spectrometry. RESULTS: 289 MRI studies were available from 115 patients during the period studied. 9.4% of patients had overt diabetes and an additional 16% of patients had impaired fasting glucose. Both pancreatic and cardiac R2* had predictive power (p<0.0001) for identifying diabetes. Cardiac and pancreatic R2* were modestly correlated with one another (r(2) = 0.20, p<0.0001). Both were weakly correlated with LIC (r(2) = 0.09, p<0.0001 for both) and serum ferritin (r(2) = 0.14, p<0.0001 and r(2) = 0.03, p<0.02, respectively). None of the three served as a screening tool for single observations. There is a strong log-log, or power-law, relationship between ratio of signal intensity (SIR) values and pancreas R2* with an r(2) of 0.91. CONCLUSIONS: Pancreatic iron overload can be assessed by MRI, but siderosis in other organs did not correlate significantly with pancreatic hemosiderosis.

Multiple myeloma complicated with pseudomonas endocarditis.

Patients diagnosed with multiple myeloma are more susceptible to infections which are the major causes of morbidity and mortality associated to this disease. The main infectious agents involved are Gram-positive bacteria. However, after chemotherapy an increase in the incidence of Gram-negative strains is observed. These bacteria are also responsible for most cases of urinary tract infections. Here is reported a rare case in a 73-year-old man with multiple myeloma who developed endocarditis due to pseudomonas.

Tromboflebite plantar: achados em ressonância magnética / Plantar thrombophlebitis: magnetic resonance imaging findings

OBJETIVO: Demonstrar os achados em ressonância magnética (RM) da tromboflebite plantar. MÉTODOS: Revisão retrospectiva de 20 pacientes com dor na região plantar nos quais os achados de ressonância magnética indicaram tromboflebite plantar. RESULTADOS: Foram avaliados 14 homens e seis mulheres, com idade média de 46,7 anos. Oito desses pacientes também foram submetidos à ultrassonografia com doppler, que confirmaram a tromboflebite. As imagens de ressonância magnética foram avaliadas em consenso por dois radiologistas com experiência em radiologia do sistema musculoesquelético (mais de 10 anos cada um), demonstrando edema perivascular em todos os 20 pacientes (100%) e edema muscular em 19 dos 20 pacientes (95%). Todos os 20 pacientes apresentavam intensidade de sinal intermediária intraluminal em T2 (100%) e ectasia venosa estava presente em 17 dos 20 casos (85%). Veias colaterais foram visualizadas em um dos 20 pacientes (5%). Todos os 14 casos (100%), nos quais o contraste intravenoso foi administrado, apresentavam realce dos tecidos perivenulares e defeito de enchimento intraluminal. Ectasia venosa, perda da compressibilidade e ausência de fluxo na ultrassonografia com doppler também foram observados em todos os oito casos examinados pelo método. CONCLUSÕES: A RM é um método sensível na avaliação de tromboflebite plantar em pacientes com dor plantar.

BJECTIVE: demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis.METHODS: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. RESULTS: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method.CONCLUSIONS: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain.

Carcinoma verrucoso da mão: uma rara apresentação avaliada por ressonância magnética / Verrucous carcinoma of the hand: a rare presentation evaluated by magnetic resonance imaging

O carcinoma verrucoso é uma variante do carcinoma de células escamosas, vista em mucosas e pele, raramente encontrada na mão. Nós relatamos um caso de duas lesões no dorso da mão, sem contato entre si, que foram ressecadas em bloco e confirmadas como carcinoma verrucoso.

Verrucous carcinoma is a variant of squamous cell carcinoma seen in mucous membranes and skin, and rarely found in the hand. The present report describes a case of two lesions on the dorsum of the hand, with no contact to each other, which underwent en-block resection and were confirmed as verrucous carcinoma.