Plantar fascia: imaging diagnosis and guided treatment.

Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal. Ultrasound demonstrates low echogenicity compared with the echogenic plantar fascia. Penetrating injuries can appear bizarre due to associated foreign body impaction and infection. Achilles tendonopathy can cause heel pain and should be considered as a possible diagnosis. Treatment options include physical therapy, ECSWT, corticosteroid injection, and dry needling. Percutaneous US guided treatment methods will be described.

[Changes of 3-tesla 31P-MR spectroscopy of bone and soft tissue tumors].

OBJECTIVE: To study the characteristic changes of 31P-MR spectroscopy of bone and soft tissue tumors. METHODS: 41 patients were examined by phosphorus surface coil of 3 tesla MR machine, including 18 benign tumor foci and 28 malignant foci, and adjacent normal muscles. The areas under the peaks of various metabolites in the spectra were measured, including phosphomonoester (PME), inorganic phosphours (Pi), phosphodiester (PDE), phosphocreatine (Pcr), adenosine triphosphate (ATP) gamma, alpha, beta. The ratios of the metabolites to beta-ATP, NTP and Pcr were calculated. Intracellular pH was calculated according to the chemical shift change of Pi relative to Pcr. RESULTS: The ratios of Pcr/PME and PME/NTP in benign and malignant tumor groups were significantly different from those of the normal group (P<0.05). Between benign and malignant tumor groups, the ratios of PME/beta-ATP and PME/NTP were significantly different (P<0.05). CONCLUSION: Pcr/PME and PME/NTP are potential diagnostic indexes of bone and soft tissue tumors. PME/beta-ATP and PME/NTP are potential indexes of differential diagnosis of bone and soft tissue tumors.

Left ventricular cardiac fibroma in a child presenting with ventricular tachycardia.

Cardiac tumors in children are rare. Although most are histologically benign, they can be associated with life-threatening arrhythmias and sudden death. We report a 7-year-old boy, with a first episode of symptomatic tachycardia, who was found to have a left ventricular (LV) fibroma. He had a normal echocardiogram prior to an electrophysiology study, which revealed a sustained monomorphic ventricular tachycardia and a radio-opacity near the LV apex. These findings prompted a cardiac MRI, which demonstrated a discrete mass on his LV apex and free wall. Our case emphasizes that structural heart disease should be aggressively pursued in children presenting with ventricular tachycardia.

[Soft-tissue tumors: primary excision or wait and see?]. / Lipom, Atherom, Fibrom. Wann muss ein Weichteiltumor raus?

Soft tissue tumors are relatively commonly seen lesions in the doctor's office. An initial differentiation between malignant and benign tumors is usually possible on the basis of the case history and a careful physical examination. In adults, primary excision under local anesthesia is the treatment of choice in many cases, while in children and in the case of large tumors suspected of being malignant, a histological diagnosis must always be obtained. A number of procedures are available for biopsy taking. If the definitive histological work-up confirms malignancy, or if the findings are uncertain, the diagnostic investigation should be extended to include such imaging procedures as CT scanning or MRI.

[Giant fibroma of mesocolon transverse imitating tumor of ovary: a case report]. / Olbrzymi wlókniak krezki okreznicy poprzecznej imitujacy guz jajnika--opis przypadku klinicznego.

OBJECTIVES: The fibroma of mesocolon transverse is a rare lesion occurring primarily in age about 45-55 of years. The rarity of these lesions and the absence of characteristic clinical findings makes diagnosis difficult. STUDY DESIGN: The authors describe a case of fibroma mesocolon transverse in woman aged 75 years which became directed to Department of Gynecology & Obstetric in Hospital of Slupsk on account suspicions of ovarian tumor. RESULTS: Fibroma mesocolon transverse usually present as abdominal distention of long duration, pain, vomiting, less frequently as a palpable abdominal mass. Rarely they cause an acute abdominal surgical crisis clinically resembling appendicitis with peritonitis. Ultrasonography was the diagnostic method of choice. Other diagnostic modalities included intravenous pyelogram, barium enema examination, upper gastrointestinal tract series, CT scan and MRI in selected patients exclude gastrointestinal and genitourinary cysts and tumors. Histologically, several specific types could be distinguished of intra-abdominal lesions: lymphangioma, nonpancreatic pseudocyst, enteric duplication tumor, mesothelial tumor, enteric tumor, torsion of an omental segmental infarction cyst, hydatic omental cyst, omental fibromatosis tumor, ectopic ovarian cyst of the omentum, benign teratoma of the omentum or mesocolon. Treatment of choice of fibroma mesocolon transverse is always surgical (enucleation or resection of fibroma). Morbidity and mortality should be very low because of modern surgical techniques and follow-up procedures.

Case report: Spontaneous isolated mesenteric fibromatosis presenting as megaduodenum.

A case of spontaneous isolated mesenteric fibromatosis presenting as megaduodenum is reported. The lesion was small, only 2 cm in its greatest diameter. However, because of its location near the ligament of Treitz and because of its characteristic infiltrative growth pattern, the tumour involved the distal duodenum and resulted in acute angulation and obstruction early in its course. We successfully resected the mass and the patient is in fair physical condition 6 months after operation.

Sternomastoid tumor of infancy.

Sternomastoid tumor of infancy (SMTI) is the most common cause of neck mass in the perinatal period. We present seven children with this disorder, six studied prospectively. Ages at presentation ranged from 1 week to 4 weeks. Five had a history of birth trauma. Torticollis with facial asymmetry was seen in two. In six the diagnosis of SMTI was made clinically, and these patients were managed conservatively with massage and controlled stretching of the neck. Resolution of the neck mass, the torticollis, and the facial asymmetry occurred in all patients. Pathologic and radiographic findings are presented. We conclude that careful clinical assessment precludes the necessity of biopsy and emphasize the importance of conservative management of this transient problem.