RESUMEN
Iatrogenic injuries of the median nerve after surgical release for carpal tunnel syndrome resulting in the formation of a neuroma are rare. We present here the case of two patients, one with a bifid median nerve, showing in-continuity neuroma after surgical release for carpal tunnel syndrome. The patients reported persistent post-operative pain and showing symptoms. In both cases, ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the carpal tunnel. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and it is useful for evaluation of the percentage of the area affected by the tear.
RESUMEN
PURPOSE: Septic arthritis (SA), frequently involving hand and wrist, is common in rheumatoid arthritis (RA) patients due to immunomediated etiology of RA and immunosuppressive drug use. Clinical and laboratory features might not be useful to differentiate between RA relapse and superimposed SA. The role of magnetic resonance imaging (MRI) has been described in several studies. Our aim is to evaluate the role of ultrasonography (US). MATERIAL AND METHODS: In the last 4 years 31 MRI of hand and wrist has been performed in the suspect of SA complicating RA. A 1.5 T unit (Siemens Symphony, Erlangen, Germany) with standardized protocol, involving the administration of contrast medium, was used. Also US with power Doppler evaluation was performed. A Philips IU22 US scanner was used. RESULTS: Eleven points (according to Graif's study) were analyzed for every MRI and US. At MRI joint effusion (37.5% of RA relapse vs 100% superimposed SA) and soft tissue edema (25% vs 100%) were indicative of SA. At US joint effusion (31.3% of RA relapse vs 73.3% superimposed SA) and soft tissue edema (12.5% vs 60%) were indicative of SA. CONCLUSION: Our results suggest that joint effusion and soft tissue edema are markers suggestive for superimposed SA and that MRI is more sensitive in their evaluation. Although US is less sensitive than MRI, the former is important in guiding invasive procedure and evaluating patients that cannot undergo MRI.
RESUMEN
Enthesitis of the direct tendon of the rectus femoris muscle is a rare pathology which mainly affects professional athletes, and it is caused by overuse and repetitive microtrauma. Athletic jumping and kicking exert a great stress on the direct tendon of the rectus femoris muscle, and volleyball and football players are therefore most frequently affected. Enthesitis may occur suddenly causing pain and functional impairment possibly associated with partial or complete tendon injuries, or it may be a chronic condition causing non-specific clinical symptoms.We present the case of a professional volleyball player who felt a sudden pain in the left side of the groin area during a training session although she had suffered no accidental injury. The pain was associated with impaired ipsilateral limb function. Tendon rupture was suspected, and magnetic resonance imaging (MRI) was performed. MRI showed a lesion at the myotendinous junction associated with marked inhomogeneity of the direct tendon. Ultrasound (US) examination confirmed the presence of both lesions and allowed a more detailed study of the pathology.This is a typical case of enthesitis which confirms that MRI should be considered the examination of choice in hip pain, particularly when the patient is a professional athlete, thanks to its panoramic visualization. However, also US is an ideal imaging technique for evaluating tendon injuries thanks to its high spatial resolution, and it can therefore be used effectively as a second line of investigation.
RESUMEN
Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.
RESUMEN
Pathological breast conditions are rare in childhood and adolescence. The spectrum of breast disease in pediatric patients is different from that in adults and most lesions are benign. Fibroadenomas are the most common type of breast tumor in adolescent girls and young women. These lesions occasionally develop into very large masses, particularly in adolescent girls. Such masses are called solitary giant juvenile fibroadenomas, and local recurrence is unusual. We report here a case of recurrent juvenile giant breast fibroadenoma in a girl with Turner's syndrome.
