MR diagnosed chronic exertional compartment syndrome successfully treated by endoscopically-assisted fasciotomy.

Chronic exertional compartment syndrome is a subset of compartment syndrome that most frequently affects the lower extremities, often in athletic persons. It is most often characterized by calf pain shortly after the initiation of exercise and resolution of the pain soon after rest. While the pathophysiology is not completely understood, it is believed that compartment a lack of fascial compliance and increased compartment fluid leads to increased pressure, ultimately leading to a reversible ischemic state. Chronic exertional compartment syndrome was once considered a diagnosis of exclusion; however, needle manometry is an invasive way to measure intracompartmental pressure. Similarly, fasciotomy is the treatment of choice but is not without complications. We describe a case of chronic exertional compartment syndrome diagnosed by two-stage MRI and successfully treated by endoscopically-assisted fasciotomy.

Manubriosternal Joint Involvement as a Presenting Feature of Axial Spondyloarthritis.

Anterior chest wall pain is a feature of axial spondyloarthritis that is understudied. It is rarely the presenting symptom, and when present, may suggest severe disease. We present the case of a 35-year-old female with recurring presentations of debilitating chest pain, subsequently diagnosed with axial spondyloarthritis. Awareness of this presentation can lead to earlier diagnosis and treatment of patients presenting with manubriosternal joint involvement as their initial symptom of axial spondyloarthritis.

MRI of myositis and other urgent muscle-related disorders.

Myositis has many etiologies, and it can be encountered in the acute or chronic setting. Our goal is to increase the radiologist's knowledge of myositis and other urgent muscle disorders encountered in the emergent or urgent setting. We review the clinical presentation, the MRI appearance, and the complications that can be associated with these entities. Since myositis can affect multiple muscle compartments, we review how to differentiate the compartments of the appendicular skeletal in order to generate reports that relay important anatomic information to the treating physician. Given the poor sensitivity and positive predictive value of the clinical signs and symptoms used to diagnosing acute compartment syndrome, we discuss the potential use of MRI in cases of suspected but clinically equivocal compartment syndrome in the future.

Radiation-Induced Rib Fractures on Magnetic Resonance Imaging Following Proton Therapy for Breast Cancer With Pencil Beam Scanning.

Radiation-induced rib fractures (RIRF) are long-term complications associated with irradiation of the chest/chest wall. RIRFs are commonly seen in lung- or breast-cancer patients treated with stereotactic body radiotherapy (SBRT) or conventional external beam radiation therapy (EBRT), respectively. We report a case of a 31-year-old female presenting with pathological fractures of the third, fourth, and fifth ribs discovered on magnetic resonance imaging (MRI) as a complication from pencil beam scanning (PBS) proton therapy (PT), of the whole left breast and regional lymph nodes. To our knowledge, this presentation is the first to be initially reported on MRI in radiological literature.

MR imaging findings of calcinosis cutis in primary Sjogren syndrome, a rare manifestation.

Soft tissue calcifications associated with various connective tissue diseases such as dermatomyositis and scleroderma have been well documented Plaque-like sheets of subcutaneous calcifications presenting as an indurated soft tissue mass in a patient with primary Sjogren syndrome have been rarely documented in the literature. We present the magnetic resonance and conventional radiographic findings of calcinosis cutis and calcinosis circumscripta of a 47-year-old woman with biopsy proven Sjogren syndrome. We also delineate various types of soft tissue calcification, histopathology of calcinosis cutis, and current treatment options. Recognizing the magnetic resonance characteristics of this phenomenon may prove useful to radiologists, especially in the absence of clinical history and conventional radiographs.

Brace yourself: an unusual case of knee pain, an extradigital glomangioma of the knee.

The differential diagnosis for knee pain is extensive. Glomus tumors comprise approximately 1.6% of soft-tissue tumors in the extremities. Classic subungual tumors occur more frequently in women, whereas ectopic locations are more common in men. Unusual locations include the stomach; lungs; trachea; bones; intestines; fallopian tubes; and intraneural, neuromal, and intravenous locations. We present the case of a 50-year-old man with a 12-year history of enlarging right knee mass found to be a glomangioma. This case report discusses the incidence, presentation, imaging characteristics, histology, and management of glomus tumors of the knee.

Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty: Review of Radiographic and CT Findings.

Metallosis and metal-induced synovitis are well-recognized complications of metal-backed polyethylene joint prostheses and have been frequently described in the orthopedic surgery literature; however, relatively fewer articles discussing the radiologic aspects of this complication have been published. To illustrate the importance of radiologic findings in the diagnosis and management of these patients, we present a case of metallosis and metal-induced synovitis complicating two revisions of a total knee arthroplasty, caused by polyethylene liner wear and dissociation of the polyethylene liner from the metal-backed patellar prosthesis. Specific attention is given to reviewing signs that aid in diagnosis, such as the "bubble sign," "cloud sign," and "metal-line signs."

Verrucous carcinoma of the foot and enhancement assessment by MRI.

Verrucous carcinoma (VC), also known as epithelioma cuniculatum, of the foot is an uncommon low-grade squamous cell carcinoma with slow, progressive local invasion with minimal dysplasia and low potential for metastasis. We report on a case of VC and the enhancement pattern associated with it on magnetic resonance (MR) imaging. MR imaging revealed a plantar ulcer with an interesting pattern of enhancement at the base of the mass. The interface between the mass and the normal stroma exhibited a fine-filamentous pattern of enhancement, analogous to teased cotton wool, with impressive correlation to the histological appearance of our specimen. It is our opinion that VC could be included in the differential of a plantar ulcer associated with a mass that exhibits this enhancement pattern.

Secondary Tumoral Calcinosis with Intraosseous Penetration.

We report a case of a 55-year-old woman with chronic renal failure and secondary tumoral calcinosis with rare intraosseous penetration of the humerus. Typical lobulated calcifications with associated layering "milk of calcium" were present about the right shoulder and elbow on conventional radiographs, computed tomography images and magnetic resonance images. Rare appearance of cortical destruction and intraosseous extension of tumoral calcinosis into the medullary space was observed in the proximal humerus on CT and MR images. Since there is concern for pathologic fracture, radiologists should be aware of this rare complication of chronic renal disease.