Unveiling the spiral groove: a journey through clinical anatomy, pathology, and imaging.

AIM: To review the anatomy of the spiral groove, its clinical significance, and the imaging characteristics of common pathologies affecting this area, highlighting the strengths of different imaging modalities. MATERIALS AND METHODS: A comprehensive review of the spiral groove anatomy and its clinical implications and an evaluation of various imaging techniques, including radiography, ultrasound, MRI, and CT, was conducted. The review covers pathologic conditions such as Saturday night palsy, humeral fractures, tumours, and infections, with an emphasis on their imaging findings and clinical implications. RESULTS: The spiral groove provides a pathway for the radial nerve and the deep brachial artery, both crucial for upper limb function. Each imaging modality offers unique advantages: radiography is useful for initial assessment, ultrasound provides dynamic visualisation, MRI offers high-resolution soft tissue imaging, and CT is ideal for detailed bone anatomy. Understanding these imaging characteristics is essential for diagnosing fractures, assessing humeral alignment, and detecting nerve entrapment or injury. CONCLUSION: Accurate imaging of the spiral groove is essential for diagnosing and treating pathologies related to this anatomical feature. The integrative approach of using appropriate imaging modalities enhances diagnostic precision and informs therapeutic strategies, ultimately improving patient outcomes.

Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans.

PURPOSE: Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. METHODS: 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. RESULTS: The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1 VB/T1 CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. CONCLUSION: A high T1 VB/T1 CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.

Validity of ChatGPT-generated musculoskeletal images.

OBJECTIVE: In the evolving landscape of medical research and radiology, effective communication of intricate ideas is imperative, with visualizations playing a crucial role. This study explores the transformative potential of ChatGPT4, a powerful Large Language Model (LLM), in automating the creation of schematics and figures for radiology research papers, specifically focusing on its implications for musculoskeletal studies. MATERIALS AND METHODS: Deploying ChatGPT4, the study aimed to assess the model's ability to generate anatomical images of six large joints-shoulder, elbow, wrist, hip, knee, and ankle. Four variations of a text prompt were utilized, to generate a coronal illustration with annotations for each joint. Evaluation parameters included anatomical correctness, correctness of annotations, aesthetic nature of illustrations, usability of figures in research papers, and cost-effectiveness. Four panellists performed the assessment using a 5-point Likert Scale. RESULTS: Overall analysis of the 24 illustrations encompassing the six joints of interest (4 of each) revealed significant limitations in ChatGPT4's performance. The anatomical design ranged from poor to good, all of the illustrations received a below-average rating for annotation, with the majority assessed as poor. All of them ranked below average for usability in research papers. There was good agreement between raters across all domains (ICC = 0.61). CONCLUSION: While LLMs like ChatGPT4 present promising prospects for rapid figure generation, their current capabilities fall short of meeting the rigorous standards demanded by musculoskeletal radiology research. Future developments should focus on iterative refinement processes to enhance the realism of LLM-generated musculoskeletal schematics.

An evaluation of AI generated literature reviews in musculoskeletal radiology.

PURPOSE: The use of artificial intelligence (AI) tools to aid in summarizing information in medicine and research has recently garnered a huge amount of interest. While tools such as ChatGPT produce convincing and naturally sounding output, the answers are sometimes incorrect. Some of these drawbacks, it is hoped, can be avoided by using programmes trained for a more specific scope. In this study we compared the performance of a new AI tool (the-literature.com) to the latest version OpenAI's ChatGPT (GPT-4) in summarizing topics that the authors have significantly contributed to. METHODS: The AI tools were asked to produce a literature review on 7 topics. These were selected based on the research topics that the authors were intimately familiar with and have contributed to through their own publications. The output produced by the AI tools were graded on a 1-5 Likert scale for accuracy, comprehensiveness, and relevance by two fellowship trained consultant radiologists. RESULTS: The-literature.com produced 3 excellent summaries, 3 very poor summaries not relevant to the prompt, and one summary, which was relevant but did not include all relevant papers. All of the summaries produced by GPT-4 were relevant, but fewer relevant papers were identified. The average Likert rating was for the-literature was 2.88 and 3.86 for GPT-4. There was good agreement between the ratings of both radiologists (ICC = 0.883). CONCLUSION: Summaries produced by AI in its current state require careful human validation. GPT-4 on average provides higher quality summaries. Neither tool can reliably identify all relevant publications.

Imaging in international sporting event: experience from the Birmingham Commonwealth Games 2022.

AIM: To explain the design and delivery of diagnostic imaging and image-guided intervention services for an international games. The authors share their experiences from the Birmingham Commonwealth Games 2022. MATERIALS AND METHODS: A retrospective analysis was undertaken of anonymised data from the Zillion, Easyvision (RIS and PACS), and Encounter platforms for image viewing, interpretation and reporting during the Games. The data collected included age and gender, type of sport, nature of the injury, and imaging findings with diagnoses. RESULTS: The number of individuals who had radiological investigations at the Birmingham Commonwealth Games was 518 and the vast majority of them were athletes (90 %). The average age of athletes who had imaging was 28 years and that of non-athletes who accessed imaging services was 46.4 years with male predominance. Magnetic resonance imaging was the most frequently used imaging technique and the lower limb was the most frequently imaged body part. Athletes playing netball and beach volleyball had the highest percentage of injuries. CONCLUSION: The authors share their experience from the Birmingham Commonwealth Games 2022 regarding the nuances and challenges in radiology service provision for an international sports event that would be helpful for musculoskeletal radiologists in the design and delivery of similar international events in the future.

Isolated lesions of the pubis.

The osseous pelvis is a well-known area of various primary and secondary bone tumours, tumour mimics, and infections. Isolated lesions of the pubis (ILP) are rare, with few case reports in the literature. Given their sparsity, such lesions may pose a great diagnostic challenge due to varied clinical presentations and imaging features. In this study, we report the largest case series of ILP. We discuss the patient demographics, differentials, surgical approaches, and management.

Alteration of anterior cruciate ligament orientation in knees with trochlear dysplasia: description of a novel angle on MRI.

AIM: To assess changes in anterior cruciate ligament (ACL) geometry and inclination in trochlear dysplasia (TD) and analyse their significance. MATERIALS AND METHODS: Ninety-nine consecutive knees with TD and 23 normal knee magnetic resonance imaging (MRI) examinations were included as controls (n=122). Varying degrees of TD were classified into four distinct groups (A-D) according to the Dejour classification. MRI images were reviewed independently to measure four ACL angles. Interobserver and intra-observer agreements with statistical significance were determined for TD and various angles. RESULTS: A significant association was found between TD and two measured angles compared with the control group (sagittal ACL and anteromedial ACL angles, p<0.001 for each). The results indicate that TD can predispose to more vertical ACL inclination as measured in the coronal plane on MRI. No association was found with the Blumenstat angle. CONCLUSION: The present study found significant associations with TD and steeper sagittal ACL, which have been implicated in ACL failure. A novel angle (anteromedial ACL angle) is described which has significant association with TD and is specific for the anteromedial bundle as measured in the coronal plane. Careful consideration of ACL fibre orientation in the coronal plane on MRI is suggested in knees with TD and the use of this newly described angle in assessing ACL reconstruction (ACLR) grafts.

"Do-not-touch" lesions of bone revisited.

Incidental bone lesions are encountered frequently in day-to-day practice. Many of these lesions are indeterminate requiring referral to specialist centres for further characterisation with or without biopsy; however, as biopsy has its own drawbacks, not all lesions can be subjected to biopsy. The primary role of a radiologist in these situations is to characterise these lesions based on their imaging appearances into aggressive lesions requiring biopsy and non-aggressive lesions that do not require a biopsy. The term "do-not-touch lesion" is used to describe a lesion with typical radiographic appearances that can be characterised based on radiographic appearances alone without needing a biopsy. With recent advances in imaging, many incidental lesions can be characterised into do-not-touch lesions based on their imaging appearances alone using a single imaging technique or using a combination of imaging techniques and, less frequently, with the additional help of serological investigations, without the need for biopsy. Hence, the definition of do-not-touch lesions of bone needs a revisit. In this article, we attempt to redefine do-not-touch lesions of bone and propose an imaging-based classification for characterisation of these lesions.

Assessing the gender gap in musculoskeletal radiology authorship across three continents: are really the "ladies first"?

AIM: To assess gender-specific authorship trends in musculoskeletal (MSK) radiology in three major radiology journals, Skeletal Radiology (SR), Clinical Radiology (CR) and Indian Journal of Radiology and Imaging (IJRI). MATERIALS AND METHODS: Retrospective analysis of articles pertaining to MSK radiology was done for the years 2000, 2010, and 2020 for SR and CR and for the years 2010 and 2020 for IJRI. The number and positions of female authors was noted. RESULTS: Three hundred and twenty-five articles were reviewed after excluding the articles where the gender of one or more authors could not be conclusively determined. In SR, the percentage of female authors increased significantly from 4% in 2000 to 17% in 2010 (p<0.0001) and to 21.9% in 2020 (p<0.0001) with an increase in the percentage of first female authors from 0.8% in 2000 to 4.9% in 2010 and further to 5.4% in 2020. In CR, the percentage of female authors reduced from 13.8% in 2000 to 13.6% in 2010 (p=0.9798 and further reduced to 7% in 2020 (p=0.1592). In IJRI, the percentage of articles with no female authors went down from 36.4% (2010) to 26.7% (2020). CONCLUSION: There is an upward trend in female authorship in MSK radiology related articles in SR and IJRI with continued under-representation in CR. The first and middle order female authors have shown a significant increase, although the number of last female authors remains very low. Analysis of such trends in academic journals from other subspecialities in medicine needs to be undertaken to confirm or refute the findings of this study.

Differential 18F-NaF uptake in various compartments in knee osteoarthritis: an observational study using PET/MRI.

AIM: To investigate if the pattern of fluorine-18-labelled sodium fluoride (18F-NaF) uptake on integrated positron-emission tomography (PET)/magnetic resonance imaging (MRI) of bone marrow lesions (BML) and osteophytes differs between different knee compartments. MATERIALS AND METHODS: Sixteen patients with no prior history of knee injury with or without pain were recruited for the study. The images of both knees were acquired on simultaneous PET/MRI. The acquisition was done after 45 minutes of intravenous injection of 18F-NaF 185-370 MBq (5-10 mCi) for 40 minutes. Each knee was divided into eight compartments patella, trochlea, medial central femur, lateral central femur, medial posterior femur, lateral posterior femur, medial tibia, lateral tibia, and cruciate ligament insertion specifically for BML. BML and osteophytes were scored using MRI Osteoarthritis Knee Score (MOAKS) criteria and their corresponding maximum standardised uptake values (SUVmax) recorded. RESULTS: BML and osteophytes both showed statistically significant differences among knee compartments, i.e., p-value <0.000 and < 0.043 respectively. SUVmax for BML and osteophytes was greatest in the medial tibia. CONCLUSION: 18F-NaF PET/MRI showed that BML and osteophytes had differential uptake values due to bone remodelling amongst the various knee compartments and this may help to design disease-modifying osteoarthritis drugs in the future.

Calcaneal offset index to measure hindfoot alignment in pes planus.

INTRODUCTION: Pes planus is a common three-dimensional (3D) deformity characterised by forefoot abduction, the collapse of the medial longitudinal arch, and hindfoot valgus. Several radiological measurements such as anteroposterior talocalcaneal angle (Kite's) and 'Calcaneal pitch angle' (CPA) exist to calculate the degree of hindfoot alignment in these patients with variable intra- and interobserver reliability. OBJECTIVE: To describe a new radiological ancillary method of measuring hindfoot alignment, the calcaneal offset index (COI). MATERIAL AND METHODS: Anteroposterior (mortise) and lateral view weight-bearing (WB) ankle radiographs of 200 consecutive patients referred for foot and ankle pain were reviewed. Demographic details, clinical indication, and COI calculation were undertaken on the mortise view along with the measurement of CPA for each patient. A one-way analysis of variance (ANOVA) was performed. Intraclass correlation coefficient (ICC) analysis was evaluated to assess the intraclass reliability between observers. RESULTS: There was a female preponderance of 2:1 in the study population with a mean age of 51.21 years (13-86 years). The calcaneal offset was increased in pes planus (hindfoot valgus). The p-value was 0.00023 on ANOVA. The COI gave an excellent interobserver correlation with ICC of 0.9 and moderate intraobserver reliability on the ICC analysis of 0.55. CONCLUSION: The COI can be an additional index of measuring hindfoot alignment in patients with pes planus. Contrary to the traditional angular measurements, this linear transverse plane measure is easier to calculate and reproducible. COI measurement has shown moderate intraobserver reliability but excellent interobserver reliability.

Tibial tuberosity lesions.

Lesions of the tibial tuberosity are very rare but often present a diagnostic dilemma due to their unusual location and appearances. Although some pathologies affecting this region are commonly seen elsewhere in the skeleton, they may have atypical imaging appearances and morphological characteristics when present at the tibial tuberosity. The present review describes the developmental stages of the tibial tuberosity, explaining why this area is prone to degenerative tractional changes and injury, and also highlights various pathologies including benign and malignant osseous lesions and trauma/degenerative related abnormalities.

The Haleem-Botchu classification: a novel CT-based classification for lumbar foraminal stenosis.

PURPOSE: No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis. MATERIALS AND METHODS: The grading was developed as four grades: normal foramen-Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression-Grade 1, both AP/SI compression (two planes) without distortion of nerve root-Grade 2 and Grade 2 with distortion of nerve root-Grade 3. A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic. RESULTS: A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60-83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0-540, SD-108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers. CONCLUSION: The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required.

The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review.

OBJECTIVE: To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence. MATERIALS AND METHODS: Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence. RESULTS: There were 27 males and 44 females, mean age 33 years (range 12-79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10-48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence. CONCLUSIONS: Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.

MRI assessment of anatomy and pathology of the iliofemoral ligament.

The iliofemoral ligament is strongest ligament of the body. We review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the disease entities that may affect this region.

An imaging protocol for the management of central cartilage tumours of the proximal fibula.

AIM: To retrospectively review a series of solitary central cartilage tumours (CCTs) of the proximal fibula and propose an imaging protocol for their management. MATERIALS AND METHODS: Over 11 years, 48 patients were identified with a CCT of the proximal fibula. The initial magnetic resonance imaging (MRI) and follow-up imaging were assessed for tumour length, endosteal scalloping, or aggressive/malignant features. Each case was categorised according to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). The final diagnosis and outcome were reviewed to establish an appropriate imaging protocol for the management of similar cases in the future. RESULTS: The final diagnosis based on imaging alone or imaging and histopathology was enchondroma in 46 cases (96%) and atypical cartilage tumour (ACT)/low-grade chondrosarcoma in two (4%). Using the BACTIP classification, the majority were type IC (48%) with type IA the second commonest (24%). Of 19 that underwent follow-up MRI, only two revealed any increase in length, neither of which was shown to be malignant. No cases re-presented later with evidence of malignant transformation. CONCLUSION: There has been a significant increase in the number of CCTs of the proximal fibula referred to Royal Orthopaedic Hospital, Birmingham, over the past decade. This can largely be attributed to the increased use of MRI. The majority were benign with only 4% classified as an ACT. A modified BACTIP, the Fibular Atypical Cartilage Tumour Imaging Protocol (FACTIP) is presented, indicating which cases would benefit from follow-up imaging and which require referral to a specialist orthopaedic oncology service.

The diagnostic significance of pulmonary nodules on CT thorax in chondrosarcoma of bone.

AIM: To provide a diagnostic approach to pulmonary nodules in patients with chondrosarcoma. MATERIALS AND METHODS: A search of the oncology database at a specialist orthopaedic oncology referral centre was performed to identify all patients who were treated surgically for chondrosarcoma between January 2007 and December 2018. Reports from the computed tomography (CT) examinations of the thorax of these patients were reviewed. In patients who had pulmonary nodules/metastases identified on CT, data on the primary chondrosarcoma and pulmonary nodule characteristics were collected. RESULTS: Twenty point two percent of patients had a pulmonary nodule identified on either initial or follow-up staging CT of the thorax, of which 8.1% were pulmonary metastases. Patients with grade 3 and dedifferentiated chondrosarcoma were more likely to have pulmonary metastases than patients with grade 1/2 chondrosarcoma. The time interval to developing metastases was shorter in patients with grade 2/3 and dedifferentiated chondrosarcoma versus patients with grade 1 chondrosarcoma. A low proportion of patients with grade 1 chondrosarcoma developed metastases (12.5%), all of which were identified at the time of a local recurrence. Nodules ≥10mm, nodules with lobulate margins, nodules containing irregular or subtle calcification, and nodules seen bilaterally or both centrally and peripherally were more likely to represent pulmonary metastases than benign nodules. CONCLUSION: The diagnostic significance of pulmonary nodules (i.e., whether they represent pulmonary metastases or not) can be predicted by taking into account a number of factors, in particular, the histological grade of the patient's chondrosarcoma, the size and margins of the nodules, and the presence of subtle/irregular calcification.

Life as a clinical director: an insight.

The clinical director (CD) is responsible for delivering high-quality patient-focused clinically effective healthcare services, which support the core principles of patient safety, and also serves as a conduit transmitting the trust's vision and objectives to clinical staff. The CD has to have a strategy to ensure that this is delivered without compromising patient care. He/she has to speak for all staff and ensure that the directorate strategy is aligned with the vision and strategy of the trust. In the opposite direction, the CD acts as a conduit through implementation of the departmental vision and strategy. To achieve these objectives, the CD works in close collaboration with the divisional triumvirate (executive [senior management team], divisional team [mid-level], directorate/departmental team), service manager, specialty leads, and senior nurses in addition to frontline consultant radiologists to ensure planning and delivery of robust clinical services within their areas and the entire trust. The role of the CD inherently requires "out-of-the-box" strategies, innovation, and influential communication skills for continuous service improvement and effective patient management pathways and flow. The CD ensures that appropriate medical workforce is available in the department to deliver high-quality care and maximise clinical efficiencies through effective deployment of available resources.

Standard operating procedure of image-guided intervention during the COVID-19 pandemic: a combined tertiary musculoskeletal oncology centre experience.

AIM: To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. MATERIALS AND METHODS: This study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Birmingham, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. RESULTS: Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, 7 CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. CONCLUSION: By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes.

Osteochondroma-induced pseudoaneurysms of the extremities mimicking sarcoma: a report of seven contemporary and one historical case.

AIM: To provide a diagnostic approach to distinguish osteochondroma-induced pseudoaneurysm from sarcoma on imaging and prevent biopsy which may be fatal. MATERIALS AND METHODS: A retrospective study of the orthopaedic oncology database was performed to identify all patients referred to specialist orthopaedic oncology service with a final diagnosis of osteochondroma-induced pseudoaneurysm. The demographics of the cohort, the anatomical location of the osteochondromas and pseudoaneurysms, and the imaging appearances were assessed. RESULTS: Seven contemporary and one historical case of osteochondroma-induced-pseudoaneurysm were identified. There were five patients with solitary osteochondroma and three cases of hereditary multiple exostosis. Five cases underwent magnetic resonance imaging (MRI) of which pulsation artefact was present in 40%. On MRI, all the present cases demonstrated a small central pseudoaneurysm surrounded by multiple eccentric layers of thrombus and haemorrhage, which was termed the "eccentric-whorl sign". CONCLUSION: Osteochondroma-induced pseudoaneurysms are often misdiagnosed as malignant transformation of an osteochondroma or a soft-tissue sarcoma and referred for urgent biopsy. This study presents the largest case series, which includes the first documented case diagnosed in 1934. Differentiating and characterising pseudoaneurysms from sarcomas is imperative in order to prevent a biopsy, which could be fatal.