Reconstruction of A Type IIIB Hypoplastic Thumb with A Huber Opposition Transfer in A Five-Year-Old Girl: Redefining Surgical Treatment.

Thumb hypoplasia, a congenital deficiency of bony and soft tissue of thumb, is often associated with systemic syndromes like Holt-Oram syndrome, and is the second most common thumb anomaly after duplicated thumb. It has traditionally been classified into six categories, which help guide treatment including reconstruction versus pollicization (transfer of the index finger to thumb). Amputation of the thumb and pollicization is the traditional treatment for a IIIB hypoplastic thumb. A five-year-old girl presented with a classic type IIIB hypoplastic thumb in which she has absent motor function, aplasia of the metacarpal, shortened first web space, and an unstable but present carpometacarpal (CMC) joint. Instead of amputation, the thumb was reconstructed by capsulodesis to stabilize the CMC joint, Huber Transfer Opponensplasty and abductor pollicis longus transfer to restore motor function, W-plasty to deepen the first web space, and distraction to lengthen the metacarpal. The patient tolerated the multi-stage reconstruction and bony distraction well. She was followed for one year postoperatively and has demonstrated a functional thumb. This case questions the surgical algorithm for hypoplastic thumbs and suggests a revised classification system for hypoplastic thumbs which would further divide class III based on not only the stability of the CMC joint but the presence or absence of the joint as well. We propose that amputation be reserved for type III hypoplastic thumbs in which the CMC joint is absent, (revised class IIIC) and reconstruction be attempted when the joint is present irrespective of stability (revised classes IIIA and IIIB).

Cerebral Venous Thrombosis Mimicking a Discrete Brain Mass: A Case Report and Literature Review.

The differential diagnosis for a focal brain lesion in a patient with systemic lupus erythematosus (SLE) is broad and includes infection, malignancy, and vascular and inflammatory etiologies. One rarely considered vascular pathology is cerebral venous thrombosis (CVT), which is often associated with a delay in diagnosis because of variable presentation and rare incidence. We present the case of a young woman with a new discrete brain lesion that appeared in the context of highly active SLE and was ultimately diagnosed with a CVT. We provide a literature review for diagnosis and management of cerebral venous thrombosis, a potentially serious complication of untreated systemic lupus erythematosus.

High-Resolution Isotropic Three-Dimensional MR Imaging of the Extraforaminal Segments of the Cranial Nerves.

High-resolution isotropic 3-dimensional (D) MR imaging with and without contrast is now routinely used for imaging evaluation of cranial nerve anatomy and pathologic conditions. The anatomic details of the extraforaminal segments are well-visualized on these techniques. A wide range of pathologic entities may cause enhancement or displacement of the nerve, which is now visible to an extent not available on standard 2D imaging. This article highlights the anatomy of extraforaminal segments of the cranial nerves and uses select cases to illustrate the utility and power of these sequences, with a focus on constructive interference in steady-state.

The Use of an Integrated Website to Enhance the Educational Experience in a Medical School Radiology Clerkship Course.

The purpose of this study was to demonstrate the feasibility of creating an integrated website for the medical students enrolled in a core radiology clerkship and to assess the impact of this website on students' overall educational experience. An integrated website was created for the medical students and hosted on the main departmental website. The components of the website included: announcements and password-protected schedule, curriculum, student assessment, information about different radiology sections, digital resources, and fourth year opportunities. The schedule section was created using Google Calendar to facilitate automatic syncing and real-time updates to the students' mobile devices. Weblinks for resources and assignments were incorporated into the calendar entries, which could be "pushed" to students in real time. Student attitudes were assessed via an exit survey. Various website usage statistics were collected. A total of 35 students who have rotated through the month-long clerkship thus far have used the website. Overall, 80% of students accessed the website once or multiple times a day. Over 90% of students thought that the website was well organized and easy to use; having access to the schedule on a smartphone had a positive impact on overall clerkship experience; the website had an overall positive impact on their clerkship experience; and they would recommend it to visiting medical students. Since July 2013, there have been a total of 9740 page views with 4113 unique visits to the website (an average of 17 visits per day from 6 visitors per day). The authors conclude that the creation of an integrated website has a positive impact on students' overall educational experience.

Atypical Neuroimaging Manifestations of Linear Scleroderma "en coup de sabre".

Linear scleroderma "en coup de sabre" is a subset of localized scleroderma with band-like sclerotic lesions typically involving the fronto-parietal regions of the scalp. Patients often present with neurologic symptoms. On imaging, patients may have lesions in the cerebrum ipsilateral to the scalp abnormality. Infratentorial lesions and other lesions not closely associated with the overlying scalp abnormality, such as those found in the cerebellum, have been reported, but are extremely uncommon. We present a case of an 8-year-old boy with a left fronto-parietal "en coup de sabre" scalp lesion and describe the neuroimaging findings of a progressively enlarging left cerebellar lesion discovered incidentally on routine magnetic resonance imaging. Interestingly, the patient had no neurologic symptoms given the size of the mass identified.

BWH emergency radiology--surgical correlation: traumatic spigelian hernia with right colonic injury.

We present a case of a young man who fell off his motorbike 2 days before presentation to the hospital with a complaint of gastrointestinal upset and abdominal pain. Contrast-enhanced CT of the abdomen and pelvis demonstrated a right-sided traumatic spigelian hernia and an ascending colon injury necessitating operative repair of both.

BWH emergency radiology--surgical correlation: sigmoid volvulus.

We describe the radiological and intraoperative correlation of large bowel obstruction due to sigmoid volvulus in a 52-year-old female. The purpose of this article is to emphasize the importance of recognizing sigmoid volvulus as a cause of bowel obstruction in patients presenting with abdominal pain, since it can lead to bowel ischemia and necrosis.

Correction of a contour deformity associated with frontal pneumosinus dilatans using surgical navigation technology.

Pneumosinus dilatans (PD) is a pathologic hyperaeration of the paranasal sinuses of unknown etiology. Although benign itself, PD has been associated with a number of serious concomitant conditions, including meningioma, optic nerve tumors, and visual loss. Patients with PD often present with cosmetic complaints, desiring recontouring of the facial bones to achieve an improved appearance of the face. The present case illustrates one of the first attempts at intraoperative surgical navigation to map the frontal sinus during correction of the facial deformity caused by PD. The navigation device was used to give the surgical team real-time information during the case to prevent violation of the posterior table of the frontal sinus, allowing for facial bone contouring to occur in a more efficient and safer manner by way of accurate osteotomy placement with no wasted bone for reconstruction and no accidental intracranial involvement.

BWH emergency radiology-surgical correlation: pancreatic laceration.

We describe the radiological and intraoperative correlation of pancreatic laceration in a 76-year-old unrestrained motor-vehicle driver following blunt abdominal trauma. The purpose of this article is to emphasize the importance of recognizing pancreatic injuries in trauma patients, as these injuries are rare and can be overlooked on CT.

Neuroimaging and renal ultrasound manifestations of Oculocerebrorenal syndrome of Lowe.

Oculocerebrorenal syndrome of Lowe (OCRL) is a multisystem disorder characterized by congenital cataracts, hypotonia, and cognitive developmental delay with renal complications developing in the first few months of life. Clinical and laboratory findings of Lowe syndrome are well documented. Though a small number of case reports describe the neuroimaging features and the renal ultrasound manifestations of this disease, a comprehensive review of all the imaging manifestations has not been reported. The authors present a case of OCRL and review the neuroimaging and renal ultrasound manifestations of this multisystem disease.

Diffuse cutaneous allergic reaction to Dermabond.

Wound closure with 2-octyl cyanoacrylate (Dermabond; Ethicon, Somerville, New Jersey USA) has recently increased in popularity across a wide spectrum of physicians ranging from surgeons to emergency medicine practitioners. Generally, very few complications are associated with Dermabond and are usually related to application techniques. Uncommonly, patients present with allergic reactions to the adhesive compounds; these allergies are often misdiagnosed as cellulitis or another infectious process, and are incorrectly treated. This report describes a rare case of a diffuse cutaneous allergic reaction to Dermabond following its use to close a surgical incision, its prompt identification, and treatment after presentation to an emergency department.

Evidence-based medicine in plastic surgery: where did it come from and where is it going?

OBJECTIVES: Evidence-based medicine, particularly randomized controlled trials, influence many of the daily decisions within plastic surgery as well as nearly every other medical specialty, and will continue to play a larger role in medicine in the future. Even though it is certainly not a new idea, evidence-based medicine continues to remain a hot topic among members of the healthcare community. As evidence-based medicine continues to grow and evolve, it is becoming more important for all physicians to understand the fundamentals of evidence-based medicine: how evidence-based medicine has changed, and how to successfully incorporate it into the daily practice of medicine. RESULTS: Admittedly, the wide acceptance and implementation of evidence-based medicine has been slower in surgical fields such as plastic surgery given the difficulty in performing large scale blinded randomized controlled trials due to the inherent nature of a surgical intervention as a treatment modality. Despite these challenges, the plastic surgery literature has recently begun to respond to the demand for more evidence-based medicine. CONCLUSIONS: Today's plastic surgeons are making a concerted embrace evidence-based medicine by increasing the amount of out of high-level clinical evidence and should be encouraged to continue to further their endeavors in the field of evidence-based medicine in the future.

BWH emergency radiology-surgical correlation: omental hematoma with active extravasation: a rare diagnosis.

We describe the radiological and intraoperative correlation of a large omental hematoma with active intra-abdominal bleeding secondary to omental lacerations in a 75-year-old man following blunt trauma from a motor vehicle accident. The purpose of this article is to emphasize the importance of recognizing omental and mesenteric injuries in trauma patients, as these injuries are rare and can be overlooked on CT.

Imaging in laparoscopic cholecystectomy--what a radiologist needs to know.

Laparoscopic cholecystectomy is the gold standard treatment option for cholelithiasis. In order to properly assess for the complications related to the procedure, an understanding of the normal biliary anatomy, its variants and the normal postoperative imaging is essential. Radiologist must be aware of benefits and limitations of multiple imaging modalities in characterizing the complications of this procedure as each of these modalities have a critical role in evaluating a symptomatic post-cholecystectomy patient. The purpose of this article is describe the multi-modality imaging of normal biliary anatomy and its variants, as well as to illustrate the imaging features of biliary, vascular, cystic duct, infectious as well as miscellaneous complications of laparoscopic cholecystectomy. We focus on the information that the radiologist needs to know about the radiographic manifestations of potential complications of this procedure.

Pneumosinus dilatans: is it more than an aesthetic concern?

BACKGROUND: Pneumosinus dilatans (PD) is a pathologic condition involving the hyperaeration of one or several of the paranasal sinuses that can lead to significant deformation of the overlying bone. Although the presenting complaint of patients with PD is most commonly aesthetic in nature, the condition has also been associated with intracranial tumors and several other serious conditions. MATERIALS AND METHODS: A meta-analysis of all available clinical publications on the subject of PD was conducted. Patients were categorized on the basis of their sinus involvement. Associated conditions were also identified and categorized. The resulting data were used to further characterize the condition and describe previously unreported associations between PD and other conditions. RESULTS: To date, a total of 123 cases of PD have been reported. The frontal sinus was the most commonly involved (63%), followed by the sphenoid sinus (24%), maxillary sinus (20%), and ethmoid sinus (19%). Of patients with symptomatic PD of the frontal sinus, 25% had intracranial pathology (meningioma or arachnoid cyst or orbital tumor). Patients with sphenoid PD had an 83% chance of having associated diagnosis of visual loss, meningioma, or arachnoid cyst, whereas patients with ethmoid PD had 83% chance of having associated diagnosis of exophthalmos, vision loss, or arachnoid cyst. CONCLUSIONS: Although the presenting complaint of patients with PD is most commonly aesthetic in nature, a significant percentage may have an associated diagnosis. Health care providers must be able to recognize the condition and carry out the appropriate clinical evaluation to avoid missing an associated diagnosis.

Traumatic lumbar hernia: can't afford to miss.

We describe the radiological and surgical correlation of an uncommon case of a traumatic lumbar hernia in a 22-year-old man presenting to the emergency department following a motor vehicle accident. Computed tomography (CT) of the abdomen revealed a right-sided traumatic inferior lumbar hernia containing a small amount of fat through the posterior lateral internal oblique muscle with hematoma in the subcutaneous fat and adjacent abdominal wall musculature, which was repaired surgically via primary closure on emergent basis. The purpose of this article is to emphasize the importance of diagnosing traumatic lumbar hernia on CT and need for urgent repair to avoid potential complications of bowel incarceration and strangulation.