Similar appearance of different multifocal carpal bone destructing disease entities in 3 patients: A case report.

RATIONALE: Several diseases feature tumors, or tumor-mimicking lesions, that further invade the bone and surrounding joints of the wrist region. Here, we describe 3 rare cases of multiple destructed carpal bones and adjacent joints in different disease entities confirmed via pathologic diagnosis. PATIENT CONCERNS: All 3 cases were examined between January 2016 and December 2019. Three patients presented with similar clinical manifestations and radiographic features, with multiple osteolytic lesions in the carpal bones and metacarpal bone base. DIAGNOSES: The 3 cases were diagnosed as diffuse type tenosynovial giant cell tumor, calcifying aponeurotic fibroma, and rheumatoid arthritis. INTERVENTIONS: Separate, experienced radiologist and pathologist took part in the interpretation and compartmentalization of radiographs and pathological findings, respectively. Even magnetic resonance imaging could not achieve a diagnosis; surgical excision was therefore required, with subsequent pathological assessment for treatment and final diagnosis. OUTCOMES: functional outcomes also differed among patients, poorest in rheumatoid arthritis patient. LESSONS: We report 3 rare disease entities, presenting with multifocal osteolytic lesions in the wrist. They all presented with similar clinical manifestations, and the final diagnoses were made via pathological evaluation. Compared with tenosynovial giant cell tumor and calcifying aponeurotic fibroma, rheumatoid arthritis had the poorest outcome.

Angiographic Findings of the Median Artery in Two Patients with Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy. The majority of CTS cases are idiopathic and affect females between 40 and 60 years old. Conversely, this report describes two female patients in their mid-30's diagnosed with CTS caused by a median artery in the carpal tunnel using ultrasonography. We visualized the median artery which emerged from the radial artery and common interosseous artery in the proximal forearm of each patient by magnetic resonance angiography (MRA) before surgery. After the vertical incision of the transverse carpal ligament, the anomalous vessel was encountered, which ran over the median nerve at the radial aspect, and a simple mini-open procedure was performed for carpal tunnel release. Postoperatively, the CTS symptoms were relieved in both patients. The purpose of this report is to describe the persistent median artery using MRA in two patients and to report on their postoperative mini-open carpal tunnel release outcomes.

Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment.

PURPOSE: Adhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients' prognosis. METHODS: We enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position. RESULTS: On MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified. CONCLUSION: Based on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment.

Focal Xanthogranulomatous Pyelonephritis Associated with Xanthogranulomatous Cholecystitis: A Case Report.

Xanthogranulomatous inflammation is a rare inflammatory reaction, characterized by lipid-laden macrophages, known as xanthomas, in histopathologic examination. Aggressive xanthogranulomatous inflammation often manifests as local infiltration but does not affect distant organs unless combined with rare systemic diseases. We report a case of focal xanthogranulomatous pyelonephritis (XGP) associated with severe xanthogranulomatous cholecystitis. Focal XGP was suspected in radiologic examination that showed a cystic lesion with an infiltrative margin, which were surgically resected and confirmed in pathologic examination. To our knowledge, this is the first report of focal xanthogranulomatous pyelonephritis associated with xanthogranulomatous cholecystitis. Moreover, we found peripheral hypointensity around the cystic lesion in the T2-weighted image, probably reflecting hemorrhage and fibrosis of the xanthogranulomatous inflammation.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver.

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Functional Effects of Single Semitendinosus Tendon Harvesting in Anatomic Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Hamstring Harvesting.

BACKGROUND: This study aimed to determine the effects of single semitendinosus tendon (ST) harvesting for anterior cruciate ligament (ACL) reconstruction by comparing outcomes of single ST and semitendinosus-gracilis tendon (ST-G) harvesting. METHODS: ACL reconstruction with ST-G harvesting (D group, n = 60) or single ST harvesting (S group, n = 60) were included according to inclusion criteria. Subjective assessments included subjective International Knee Documentation Committee score, Lysholm score, and Tegner activity scale score. Objective assessments included isokinetic strength and functional tests. These tests were completed at 36 months of follow-up. Magnetic resonance imaging (MRI) and second-look arthroscopy findings were evaluated. In the S group, regeneration properties were assessed by serial ultrasonography (US). RESULTS: The S group showed significantly less deep flexor strength deficit than the D group (p < 0.001). Deep flexor power deficits showed significant correlation with the shift of musculotendinous junction of the ST. There was significant difference in the cocontraction test between the groups (p = 0.012), and the S group tended to show better results in other functional tests at the last follow-up. There were no significant differences in graft tension and synovial coverage on second-look arthroscopy between the groups. In the S group, the regeneration rates assessed by US at the joint line and distal insertion were 81.7% and 80%, respectively at 6 months of follow-up. CONCLUSIONS: The S group showed significantly less deficit in deep flexor strength and tended to show better clinical results at the last follow-up than the D group. In the S group, more than 80% showed good regeneration at the 6-month follow-up. Hence, single ST harvesting is effective in minimizing flexor weakness and functional deficits and shows great potential for regeneration.

Relationships among tendon regeneration on MRI, flexor strength, and functional performance after anterior cruciate ligament reconstruction with hamstring autograft.

BACKGROUND: There are numerous reports on hamstring tendon regeneration after harvest for anterior cruciate ligament (ACL) reconstruction. However, few studies have evaluated the relationships among the magnetic resonance imaging (MRI) findings of hamstring regeneration, muscle strength, and functional results. PURPOSE: This study evaluates the correlations among the hamstring regeneration on MRI, flexor strength, and functional performance after hamstring tendon harvesting in ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We enrolled 45 patients who underwent primary ACL reconstruction using hamstring tendon autografts and in whom flexor strength, functional performance, and preoperative and postoperative MRI results were evaluated at least 2 years postoperatively. Isokinetic flexion strength was tested in the standard and prone positions. We evaluated the differences in flexor strength and functional performance according to the number of regenerated tendons. The correlation between the MRI findings (the number of regenerated hamstring tendons and proximal shift of the musculotendinous junction) and the functional performance and flexor strength was analyzed. RESULTS: The patients were divided into 3 groups according to the regeneration of the hamstring tendons on MRI: both semitendinosus and gracilis tendons regenerated (group SG), only 1 tendon regenerated (group O), and no tendon regenerated (group N). Significant differences were found in the flexor deficit between group N and groups SG and O on the standard and prone position isokinetic tests. There was a significant correlation (ρ = -.472) between the number of regenerated hamstring tendons and the carioca test result. The proximal shift significantly correlated with the flexor deficit in the prone position isokinetic test (semitendinosus, r = .449; gracilis, r = .366). CONCLUSION: Hamstring tendons regenerated after harvest for ACL reconstruction in a high proportion of the patients. The flexor strength with both the standard and prone position isokinetic tests differed in the 3 groups. The number of regenerated hamstring tendons was significantly correlated with performance on the carioca test. Proximal shifting of the musculotendinous junction was significantly correlated with flexor deficit on the hyperflexion isokinetic test.

The effects of hamstring harvesting on outcomes in anterior cruciate ligament-reconstructed patients: a comparative study between hamstring-harvested and -unharvested patients.

PURPOSE: The purpose of this study was to evaluate the effects of hamstring harvesting in patients after anterior cruciate ligament (ACL) reconstruction by comparing groups with and without hamstring harvesting. METHODS: We evaluated the effect of hamstring harvesting in 73 consecutive patients who underwent ACL reconstruction: 39 patients whose hamstrings were harvested for autografts (group H) were compared with 34 patients who received allografts during the same time period (group C [control]). The cases and controls were compared by analyzing the following variables: age, height, weight, mean follow-up period, type of tissue used, and meniscal surgery. Outcomes were assessed by the Lysholm knee score, Tegner activity score, and KT-2000 side-to-side difference (MEDmetric, San Diego, CA), as well as functional performance tests. The flexor deficit and isokinetic peak torque for knee flexion were measured in the sitting position (0° to 90°), and the flexion torque at 90° was measured in the prone position (60° to 120°). RESULTS: Although significant knee flexion weakness after ACL reconstruction was observed, a significantly greater knee flexor deficit was found in autograft patients than in allograft patients (P < .001). No differences were found between groups in terms of clinical and functional results regardless of hamstring harvesting. The performance of both study groups in all 4 functional tests were significantly correlated with flexor deficit in the sitting position (P < .05) but not in hyperflexion. Significant flexor deficits in both normal and hyperflexed positions were noted in both groups when compared with the unaffected knee (group H, P < .001; group C, P = .002). CONCLUSIONS: These results indicate significant knee flexion weakness compared with the unaffected knee after ACL reconstruction regardless of hamstring harvesting. Moreover, the greater increase in knee flexor deficit in the hamstring-harvested group compared with the allograft group was statistically significant. However, clinical and functional outcomes were similar between the groups. LEVEL OF EVIDENCE: Level III, case-control study.

Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation.

PURPOSE: The purpose was to evaluate the amount of extrusion and clinical and radiographic outcomes of meniscal allograft transplantation (MAT) after use of a modified Pollard method to measure the size of the meniscus. METHODS: We analyzed 36 patients who underwent MAT between September 2002 and June 2008. Eighteen patients had preoperative allograft sizing by the conventional Pollard sizing method, and the other 18 had the size measured by our modified method, reducing the total size of the graft by 5% from the Pollard method. The mean follow-up period was 31.4 months (range, 24 to 36 months). We compared the absolute amount of extrusion and the relative percentage of extrusion between the 2 groups. We also compared the Lysholm knee score, amount of joint space narrowing on radiographs, and Kellgren-Lawrence grade. RESULTS: The absolute amount of extrusion did not differ significantly between the 2 groups. However, the mean relative percentage of extrusion was lower in the modified Pollard group (P = .037). The mean Lysholm knee score increased in all patients, but there was no significant difference between the 2 groups. There was no significant difference in terms of radiographic outcomes. CONCLUSIONS: Reducing the graft size by 5% from the Pollard method decreases the percentage of meniscal extrusion after MAT without any adverse outcome clinically or radiographically. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Medial meniscus allograft transplantation using a modified bone plug technique: clinical, radiologic, and arthroscopic results.

PURPOSE: To determine clinical, radiologic, and arthroscopic results of our meniscus allograft transplantation (MAT) by use of modified bone plug technique, which permits easy passage of the allograft by reducing the size of the posterior bone plug. METHODS: From December 2004 to December 2008, 22 consecutive patients (20 men and 2 women) with a mean age of 35.9 years underwent medial MAT with the modified bone plug method. The Lysholm score and International Knee Documentation Committee subjective knee score were documented. Joint space narrowing and Kellgren-Lawrence grade changes were evaluated on radiographs, and graft healing status, arthrosis changes in cartilage, and meniscal extrusion were investigated by magnetic resonance imaging (MRI). RESULTS: The mean follow-up was 24.9 months. The mean Lysholm score improved significantly, from 68.2 to 89.7 (P = .002). The International Knee Documentation Committee subjective knee score improved significantly, from 60.3 to 85.4 (P = .003). Joint space narrowing was insignificant, and arthrosis progression was observed in 3 of 22 cases (13.6%) on radiographs. On MRI, complete healing of the grafts was observed in 18 cases (100%), 15 cases (83.3%), and 17 cases (94.4%) at the anterior root, posterior root, and meniscal rim, respectively. Mean meniscal extrusion was 4.35 ± 1.76 mm, and arthrosis progression was observed in 4 of 18 cases (22.2%). During second-look arthroscopy, complete healing of the grafts was observed in 11 cases (100%), 9 cases (81.8%), and 10 cases (90.9%) at the anterior root, posterior root, and meniscal rim, respectively. Cartilage degeneration was advanced in 4 cases (36.4%). No significant correlations were found between meniscal extrusion and other outcomes. CONCLUSIONS: Our modified bone plug method was an effective surgical method. MRI and second-look arthroscopic examinations showed sound evidence of graft healing. Meniscal extrusion was observed in most cases but was not correlated with other clinical and radiologic outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy.

PURPOSE: To investigate the clinical, radiologic, and arthroscopic findings of pullout repair in medial meniscus root tear (MRT) and to compare the results of pullout repair and partial meniscectomy. METHODS: This study enrolled 58 consecutive patients with medial MRT who underwent partial meniscectomy (M group, n = 28) or pullout repair (R group, n = 30) between September 2003 and August 2007. The patients were evaluated by the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee score, joint space narrowing, and Kellgren-Lawrence grade on simple radiographs. Medial meniscal extrusion and the state of the meniscus and articular cartilage on magnetic resonance imaging (MRI) were documented. We performed second-look arthroscopy in 14 patients with pullout repair and evaluated fixation strength and hoop tension of the meniscus and the state of the articular cartilage. RESULTS: There were no differences in demographic data (age, sex, and body mass index) between the 2 groups. The mean follow-up was 48.5 months in the R group and 46.1 in the M group. Lysholm and IKDC scores improved significantly in both groups (P < .05). However, the R group had better Lysholm and IKDC scores and less joint space narrowing and progression of the Kellgren-Lawrence grade than the M group did (P < .05). In a subgroup analysis of the R group, medial meniscal extrusion on MRI decreased from 3.13 to 2.94 mm. Of the patients, 28 (93.3%) showed complete or partial healing of the meniscus. On MRI, 6 (20%) showed arthrosis progression. On second-look arthroscopic examinations in 14 patients in the R group, 9 (64.3%) showed normal fixation strength, 10 (71.4%) had normal restoration of hoop tension, 5 (35.7%) showed arthrosis progression, and 2 (6.7%) had repeat tears of the meniscus. CONCLUSIONS: Arthroscopic pullout repair of a medial MRT gave significantly better clinical and radiologic results than partial meniscectomy, and sound healing with restoration of hoop tension of the meniscus was observed on MRI and second-look arthroscopy. We propose that this method is an effective treatment for medial MRT. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation.

BACKGROUND: Meniscus allograft transplantation (MAT) is useful for meniscus-deficient knees. Although meniscal extrusion is common after MAT, there is no consensus regarding the criteria for normal meniscal extrusion or the relationship between clinical and radiologic results. HYPOTHESIS: Meniscal extrusion after MAT results in poor clinical, radiologic, and arthroscopic outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-six of 60 patients undergoing MAT from September 2002 to June 2007 who were available for follow-up evaluation for more than 2 years were evaluated. The study population (31 men, 5 women) consisted of 15 and 21 cases of medial and lateral meniscus transplant, respectively. Knee status was evaluated by Lysholm score, plain radiography, and magnetic resonance imaging preoperatively and postoperatively. Second-look examinations were performed in 18 cases. RESULTS: Mean follow-up was 31.4 months (range, 24-36). Lysholm knee score increased significantly (mean, 88.2; range, 70-100) on final visit versus the preoperative value (mean, 61.2; range, 26-83; P < .001). Joint-space narrowing was 0.08 mm (range, -2.58 to 1.92) in extension AP and -0.09 mm (range, -2.3 to 1.8) in Rosenberg view. Kellgren-Lawrence arthrosis grade did not change in 28 knees (77.8%) and progressed by 1 grade in 8 knees. Meniscal extrusion extent was 3.87 ± 1.94 mm and relative percentage extrusion was 42.1% ± 17.7%. Seven cases (19.4%) showed minor extrusion (<3 mm), 27 (75%) showed major extrusion (>3 mm), and 2 (5.6%) showed no extrusion. Further degeneration was absent in 28 knees (77.8%) on magnetic resonance imaging. In second-look arthroscopic examinations at an average of 26.3 months, 11 of 18 (63.6%) cases showed no progression of cartilage degeneration. There was no significant correlation between meniscal extrusion and other parameters. CONCLUSION: This study indicated that MAT can improve the clinical status of the meniscectomized knee. Although meniscal extrusion occurred after surgery in most cases, there was no significant correlation with various clinical, radiologic, or arthroscopic outcomes. Further studies are required to evaluate long-term effects of meniscal extrusion.

Radiographic predictability of cartilage damage in medial ankle osteoarthritis.

BACKGROUND: Radiographic grading has been used to assess and select between treatment options for ankle osteoarthritis. To use radiographic grading systems in clinical practice and scientific studies one must have reliable systems that predict the fate of the cartilage. QUESTIONS/PURPOSES: We therefore asked whether (1) radiographic grading of ankle osteoarthritis is reliable and (2) grading reflects cartilage damage observed during arthroscopy. We then (3) determined the sensitivity, specificity, and predictive values of the radiographic findings. PATIENTS AND METHODS: We examined 74 ankles with medial osteoarthritis and 24 with normal articular cartilage based on arthroscopy. Arthroscopic findings were graded according to the modified Outerbridge grades and all radiographs were graded using the modified Kellgren-Lawrence, Takakura et al., and van Dijk et al. grading systems. The reliability of each radiographic grading system was evaluated. We correlated the radiographic grades and severity of cartilage damage for each radiographic grading system. Sensitivity, specificity, and predictive values of spurs and joint space narrowing with or without talar tilting then were determined. RESULTS: The interobserver weighted kappa ranged from 0.58 to 0.89 and the intraobserver weighted kappa from 0.51 to 0.85. The correlation coefficients for the Kellgren-Lawrence, Takakura et al., and van Dijk et al. grades were 0.53, 0.42, and 0.42, respectively. Ankles with medial joint space narrowing (Stage 2 of Takakura et al. and van Dijk et al. grades) showed varying severity of cartilage damage. The positive predictive value of cartilage damage increased from 77% for medial joint space narrowing regardless of the presence of talar tilting to 98% for medial joint space narrowing with talar tilting. CONCLUSIONS: Our observations suggest the inclusion of talar tilting in grading schemes enhances the assessment of cartilage damage. LEVEL OF EVIDENCE: Level II, diagnostic study. See the Guidelines for Authors for a complete description of level of evidence.

Posterior root tear of the medial meniscus in multiple knee ligament injuries.

The purposes of the present study were to examine the frequency and characteristics of root tears of the medial meniscus associated with ligament injuries of the knee and to evaluate the effectiveness of pull-out repair for restoring meniscus function. We retrospectively analyzed the 9 patients (10 knees) with posterior root tears of the medial meniscus and ligament injuries of the knee treated between August 2004 and February 2007. All the patients were male, with average age of 29.8 years, and the mean follow-up period was 29.7 months. The pull-out suture technique was used to repair the root tears. Clinical outcomes were evaluated using the Lysholm, IKDC, and Tegner scores, as well as the McMurray and Apley tests. The mean follow-up period was 41.1 months (range, 30 to 63 months). The incidence of root tears of the medial meniscus with ligament injuries was 2.74% (10 cases in 365 ligament surgeries). All clinical results showed significant improvement. At the final follow-up, McMurray test showed one positive and nine negative cases, and the Apley test revealed two positive and eight negative cases. There were no positive findings in anterior drawer test, posterior drawer test, valgus and varus stress test, and posterolateral instability test. Healing of the root tear was confirmed by arthroscopy in five patients and by MR in four patients. Root tears of the medial meniscus may occur in multiple knee ligament injuries. It is important not to miss them. Our results indicate that pull-out repair provides satisfactory results and evidence of healing.

Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability.

Diagnosing posterolateral rotatory instability (PLRI) is difficult because it occurs rarely, takes time to manifest, and no single definitive tool exists in diagnosing posterolateral corner injuries. We sought to evaluate the correlation between rotational degrees in the dial test and physical and arthroscopic findings that surgically verified PLRI in the knee joint. Patients (n = 67) who were diagnosed as having PLRI and received posterolateral reconstruction (n = 57) and repair (n = 10) from 1998 to 2006 were recruited. Preoperative physical findings were evaluated under anesthesia, and arthroscopic findings during surgeries were analyzed. A dial test with post-anesthesia (spinal or general) was conducted. We divided patients into three subgroups (A: <15 degrees, B: 15-20 degrees, and C: >20 degrees), according to differences in rotational degrees in the dial test. All tests showed significant differences among the three groups and positive findings increased as the rotational degrees increased. No test showed a statistically significant difference in the specific group. All tests except for popliteal hiatus widening showed significant differences among the three groups and positive findings also increased as the rotational degrees increased. The total incidence and positive rate of each physical examination and the popliteal hiatus arthroscopic findings in PLRI significantly increased as the rotational degree in the dial test increased. The number of positive findings on physical examination was larger than the number of positive findings by arthroscopy in all three groups.

Leiomyosarcoma of the ovarian vein: a case report with radiological findings.

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.

Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) findings of medial meniscal root tear and the correlation of medial meniscal root tear with other associated knee abnormalities. METHODS: We retrospectively assessed preoperative magnetic resonance images of 39 patients with arthroscopically confirmed medial meniscal root tear. Magnetic resonance imaging findings were retrospectively reviewed by 2 experienced musculoskeletal radiologists for consensus. We evaluated the configuration of meniscal root tear and the other associated knee abnormalities on MRI for direct correlation with arthroscopic findings. RESULTS: At arthroscopy, there were 36 radial tears and 3 complex tears involving the medial meniscal posterior horn roots. All 36 radial tears could be correctly diagnosed by MRI, with findings showing ghost sign on sagittal images in 100% (36/36), vertical linear defect on coronal images in 100% (36/36), and radial linear defect on axial image in 94% (34/36). However, all 3 complex tears were misdiagnosed as radial tears on MRI. Medial meniscal root tears displayed a strong association with degenerative joint disease in 97% (38/39). Medial meniscal root tears were also found in association with cartilage defects of the medial femoral condyle and medial meniscal extrusions (> or =3 mm) in 89% (34/38) and 67% (26/39), respectively. CONCLUSIONS: Medial meniscal root tears were usually posterior horn root radial tear. A high association with degenerative joint disease, cartilage defects of the medial femoral condyle, and medial meniscal extrusions (>/=3 mm) were also noted.

Fitz-Hugh-Curtis syndrome: CT findings of three cases.

Clinical manifestations and computed tomography (CT) findings of Fitz-Hugh-Curtis syndrome (FHCS) are relatively well stabilized as right upper quadrant abdominal pain and hepatic capsular enhancement because of perihepatitis associated with pelvic inflammatory disease caused by N. gonorrhoeae and C. trachomatis. We encountered three patients with serial FHCS associated with pelvic inflammatory disease, who visited the emergency room with right upper quadrant abdominal pain. Abdominal CT revealed hepatic capsular or pericapsular enhancement along the anterior surface of the liver on the arterial phase. Recently, multi-detector CT has evolved as the first-line imaging modality of acute abdomen at the emergency room; we reemphasized the importance of the CT findings of this syndrome for differential diagnosis of right upper quadrant abdominal pain in sexually active young women. Physicians at the emergency room acknowledge the syndrome and should perform dynamic abdominopelvic CT including the arterial phase.

Retrievable biliary stent-graft management of refractory postoperative bile leakage.

The authors report a case of a successful outcome after retrievable biliary stent-graft management in a patient with refractory postoperative bile leakage. A 52-year-old man who underwent a Whipple operation presented with postoperative bile leakage. A percutaneous transhepatic biliary drainage (PTBD) catheter remained from the operation, and bile leakage persisted after 7 days of drainage with the catheter. A retrievable biliary stent-graft was placed; it was removed 14 days later. Cholangiography indicated patency of the anastomosis without contrast medium leakage, and the PTBD catheter was removed. There were no procedural-related complications.

Inferior phrenic artery: anatomy, variations, pathologic conditions, and interventional management.

The inferior phrenic artery (IPA) is the most common source of extra-hepatic collateral blood supply for hepatocellular carcinoma (HCC) and frequently supplies HCCs located in the bare area of the liver. Other pathologic conditions including hemoptysis, diaphragmatic or hepatic bleeding due to trauma or surgery, and bleeding caused by gastroesophageal problems (eg, Mallory-Weiss tear or gastroesophageal cancer) may be related to the IPA. Over a 4-year period, the authors performed 383 interventional procedures related to the IPA. The right and left IPAs originate with almost equal frequency from the aorta and celiac axis and with lesser frequency from the renal arteries. Various other sites of origin-such as the left gastric, hepatic, superior mesenteric, spermatic, and adrenal arteries-are also seen. Radiologists must be familiar with the normal spectrum of IPA anatomy so that detection and adequate interventional management can be achieved when pathologic conditions related to the IPA are present.