Diagnosis and Management of Acute Thrombosis in Venous Dominant Orbital Venolymphatic Malformations.

PURPOSE: To report the characteristic clinical and imaging findings in a series of patients with thrombosed orbital venolymphatic malformations. METHODS: Patients affected by acute thrombosis of an orbital venolymphatic malformation were reviewed. Clinical findings including symptoms and signs of presentation, characteristic imaging features, and clinical course are presented. RESULTS: Ten patients were identified. The mean age at presentation was 56 years. All patients presented with acute pain or pressure sensation, with the most common additional presenting symptoms being proptosis (6/10) and diplopia (5/10). CT imaging typically demonstrated a nonspecific orbital mass. Nine patients underwent MRI which revealed a soft tissue mass with peripheral rim enhancement and a central, typically T2 hypointense, core. Seven out of 10 patients were observed and had improvement in symptoms and signs without surgical intervention. Two patients underwent surgical intervention for intractable pain. CONCLUSION: Patients with thrombosis of a venolymphatic malformation often present with acute pain, proptosis, and diplopia. Characteristic MRI findings of a peripheral rim enhancing mass with a T2 hypointense core can be noted. Careful observation is a reasonable management option for cases without visual compromise or intractable pain.

Performance of a handheld ultrasound device in detecting retinal detachments.

PURPOSE: To assess the accuracy and performance of the Butterfly IQ+ handheld ultrasound (HHUS) in detecting retinal detachments (RDs). METHODS: A cross-sectional observational study of eyes with (n = 20) and without (n = 20) RD imaged using a conventional B-scan ophthalmic ultrasound device Ellex Eye Cubed by Clarion Medical Technologies (Cambridge, ON, CA) and a portable HHUS (Butterfly IQ+). Images were compared between the modalities for qualitative differences. Agreement between the HHUS and standard ultrasonography equipment and with clinical examination was quantified using Cohen's kappa coefficient. RESULTS: Forty eyes of 33 patients were included in the study. Twenty eyes of 18 patients had RDs, and 20 eyes of 18 patients did not. The observed agreement in RD diagnosis between the Butterfly and the Ellex Eye Cubed was 97.5%., and the Cohen's Kappa was 0.950 (95% CI: 0.85-1.00). The observed agreement in RD diagnosis between the Butterfly IQ+ and diagnosis confirmed by the gold standard of clinical exam was 92.5%, and Cohen's Kappa was 0.850 (95% CI: 0.69-1.00). The sensitivity and specificity of the Butterfly ultrasound in RD diagnosis were 90% (95% CI: 68.3-98.8%) and 95% (95% CI: 83.2-100), respectively. CONCLUSION: There was a high degree of agreement between the systems for the identification of RD. The Butterfly IQ's extreme portability and ease of use make it a viable option to screen for RDs in hospital-based consults, emergency departments, or low-resource settings.

Use of a handheld ultrasound device for detecting orbital inflammation.

Purpose: Orbital inflammatory disease has been historically diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Orbital ultrasound has served as a non-radiation alternative that has been successful at diagnosing many orbital pathologies but is not commonly used in clinical practice due to need for specialized ultrasound training and equipment needs. We demonstrate use of handheld ultrasound for detecting orbital inflammation. Observations: We present five patients with orbital inflammation where a handheld ultrasound probe was able to capture features consistent with concurrent CT scans. Conclusions and importance: Handheld ultrasound is an accessible and portable method that can assist in the diagnosis and monitoring of orbital pathology.

Effects of Micronized Cartilage Matrix on Cartilage Repair in Osteochondral Lesions of the Talus.

BACKGROUND: The repair of osteochondral lesions remains a challenge due to its poor vascularity and limited healing potential. Micronized cartilage matrix (MCM) is dehydrated, decellularized, micronized allogeneic cartilage matrix that contains the components of native articular tissue and is hypothesized to serve as a scaffold for the formation of hyaline-like tissue. Our objective was to demonstrate in vitro that the use of MCM combined with mesenchymal stem cells (MSCs) can lead to the formation of hyaline-like cartilage tissue in a single-stage treatment model. DESIGN: In group 1 (no wash), 250 µL MCM was reconstituted in 150 µL Dulbecco's phosphate-buffered saline (DPBS) for 5 minutes. Group 2 (saline wash) included 250 µL MCM washed in 20 mL DPBS for 30 minutes, then aspirated to remove all DPBS and reconstituted in 150 µL DPBS. Group 3 (serum wash): 250µL MCM washed in 20 mL DPBS for 30 minutes, then aspirated and reconstituted in 150 µL fetal bovine serum. Each group was then added to 50 µL solution of MSC suspended in DPBS at a concentration of 1.2 × 106 cells/350 µL. After 3 weeks, the defects were extracted and sectioned to perform viability and histologic analyses. RESULTS: Stem cells without rehydration of the MCM showed almost no viability whereas near complete cell viability was seen after rehydration with serum or saline solution, ultimately leading to chondrogenic differentiation and adhesion to the MCM particles. CONCLUSION: We have shown in this proof-of-concept in vitro study that MCM can serve as a scaffold for the growth of cartilage tissue for the treatment of osteochondral lesions.