Intraosseous gout mimicking giant cell tumor of the patella.

Intraosseous gout involving the patella is an unusual presentation of the common inflammatory crystal deposition disease. In most reported cases of gout in the patella, there is prominent involvement of the adjacent patellar or quadriceps tendons of the extensor mechanism. A report from Japan describes another pattern of deposition, with a lesion arising in the synchondrosis of a bipartite patella. We present a case of a patient with no known history of gout experiencing vague anterior knee pain and subtle but rapidly progressive findings of a patellar lucent lesion on radiographs. No other cause for the patient's pain was identified on imaging. No prominent involvement of surrounding tendinous structures on MRI, unipartite patellar morphology, normal serum uric acid levels, rapid growth, and nonspecific appearance of the lesion led to a working diagnosis of patellar giant cell tumor. Biopsy of the lesion was performed to guide further management, which yielded the unexpected result of crystalline deposits consistent with gout.

Role of prostate artery embolization in the management of refractory haematuria of prostatic origin.

Prostatic haematuria is among the most common genitourinary complaints of emergency room visits, distressing and troublesome to men and a challenging clinical problem to the treating physician. The most common aetiologies of prostatic haematuria include benign prostatic hyperplasia and prostate cancer. Prostatic haematuria usually resolves with conservative and medical methods; failure of these interventions results in refractory haematuria of prostatic origin (RHPO), a potentially life-threatening scenario. Several different treatments have been described, with varying degrees of success. Patients with RHPO are often elderly and unfit for radical surgery. Prostate artery embolization (PAE) has evolved as a safe and effective technique in the management of RHPO. Use of a superselective approach optimizes clinical success while minimizing complications. This minimally invasive approach improves patients with haemodynamic instability, serves as a bridge to elective surgery, and is a highly effective treatment for RHPO. It may obviate the need for more invasive and morbid surgical therapies. The aim of the present review was to describe the current management of RHPO and the technique of PAE and to review its efficacy and associated morbidity.

Retrobulbar magnetic resonance angiography using binomial off-resonant rectangular (BORR) pulse.

PURPOSE: Applying a newly developed binomial off-resonant rectangular (BORR) pulse method for high resolution three-dimensional MR angiography (MRA) on retrobulbar ocular vessels, which has not been possible with routine MRA due to background fatty tissues. METHODS: BORR pulse was implemented in a gradient echo sequence by replacing the original excitation pulse, and were optimized for robust orbital fat suppression. Several other MRA methods, with or without fat suppression, were also compared, including time-of-flight, contrast enhanced MRA, and hybrid of opposite-contrast MRA. Nine healthy subjects participated with written informed consents. To reduce eye motion, the subjects were instructed to casually stare at a projected cross during each MRA scan. Major vessels were evaluated by three independent radiologists using a 4-point scale. RESULTS: The BORR method yielded the best MRA results for retrobulbar vessels without contrast enhancement, significantly superior than other MRA methods. BORR results had significantly higher visibility scores than all other methods for small vessels. CONCLUSION: We have successfully revealed orbital vessels in retrobulbar space for the first time using MRA, by using the BORR pulse method. With a clear depiction of the vasculature without the need for contrast enhancement, our method has the potential to provide important diagnostic information for ocular vascular diseases.