Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case. / Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso.

OBJECTIVES: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. MATERIAL AND METHOD: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. RESULTS: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). DISCUSSION: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. CONCLUSIONS: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.

Radiofrequency thermal ablation of osteoid osteomas of the proximal femur. Usefulness of ultrasound guidance in selected cases.

PURPOSE: To review symptoms and imaging findings of proximal femoral osteoid osteomas (OO); to analyse the results of a thermal ablation technique for radiofrequency of the nidus in this location; and to describe usefulness of ultrasound guidance in selected cases. MATERIAL AND METHOD: Descriptive and retrospective study consisting of 8 patients with OO in the proximal epiphysis of the femur, which were treated by thermal ablation of the nidus with radiofrequency waves from 1998 to 2004. RESULTS: The mean pain period until the performance of the thermal ablation was 11.5 months (range 5-18 months). There were no complications, and all patients stated that the pain was gone by the day following the procedure, with some discomfort during the first week, except for one where it lasted more than one month due to technique difficulties. At present, with a mean follow up of 6 years and 2 months (range 6-190 months), all patients remain asymptomatic and live a rigorous normal life. DISCUSSION: Thermal ablation with CT-guided radiofrequency waves is a safe, effective and efficient procedure. CONCLUSION: Normal appearance of a proximal femoral OO does not differ significantly from other location osteomas and its diagnosis is easier with previous knowledge. Thermal ablation of the nidus with radiofrequency waves, that may be performed using ultrasound guidance, appears to be the elective treatment of choice due to its efficiency and minimum morbidity.

Síndrome de Pellegrini-Stieda como causa de gonalgia / Pellegrini-Stieda syndrome as a cause of knee pain

La calcificación de las partes blandas, adyacentes al cóndilo femoral medial, después de una historia de traumatismo en la rodilla, se denomina signo radiológico de Pellegrini-Stieda (PS), cuando se asocia a dolor y a disminución del rango de movilidad de la rodilla se conoce como síndrome de PS. Describimos dos casos de síndrome de PS, tratados mediante tratamiento conservador -reposo y fisioterapia-, los hallazgos radiológicos y ecográficos, y algunas teorías propuestas para explicar la patogénesis de la enfermedad de PS (AU)

Calcification in the soft tissue next to the medial femoral condyle after a history of trauma around the knee is a recognized radiographic finding-PS (Pellegrini-Stieda) sign. When this is associated with pain and a restricted range of motion it is known as the PS syndrome. We describe two cases of PS syndrome, treated conservatively with rest and physiotherapy, as well as the radiographic and ultrasound findings, and the many theories proposed in attempts to explain the pathogenesis of PS disease (AU)

[Pellegrini-Stieda syndrome as a cause of knee pain]. / Síndrome de Pellegrini-Stieda como causa de gonalgia.

Calcification in the soft tissue next to the medial femoral condyle after a history of trauma around the knee is a recognized radiographic finding-PS (Pellegrini-Stieda) sign. When this is associated with pain and a restricted range of motion it is known as the PS syndrome. We describe two cases of PS syndrome, treated conservatively with rest and physiotherapy, as well as the radiographic and ultrasound findings, and the many theories proposed in attempts to explain the pathogenesis of PS disease.

Luxación de la articulación metatarso falángica del 2° dedo como causa de metatarsalgia / Luxation of the metatarsophalangeal joint of the 2nd finger as a cause of forefoot pain

Presentamos dos casos de luxación dorsal de la segunda articulación metatarsofalángica, como causa de metatarsalgia. Aunque clínicamente puede confundirse con otras patologías, como el neuroma interdigital, el conocimiento del proceso y una simple radiología convencional, la diagnosticaría sin necesidad de otras pruebas complementarias. Se realizó intervención quirúrgica de la deformidad dolorosa y se completó con resección de la base de la falange proximal de los dedos del pie (AU)

We report 2 cases of dorsal dislocation of the second metatarsophalangeal joint, a source of forefoot pain. Although clinically they could be mistaken for other pathologies, such as interdigital neuroma, the knowledge of the entity, and simple roentgenographic examination, should diagnose them without the need for other complementary tests. Surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of second toes (AU)

Osteonecrosis de un sesamoideo del pie como causa de metatarsalgia. Aspectos clínico-radiológicos / No disponible

Varón de 37 años de edad con metatarsalgia a la deambulación. El dolor se localizaba en la zona plantar de la primera articulación metatarsofalángica. En la radiografía convencional se objetivó fragmentación y esclerosis heterogénea. La resonancia magnética confirmó el diagnóstico de necrosis avascular del sesamoideo medial. Se trató conservadoramente con medicación antiinflamatoria y medidas ortopédicas. Aunque no existen muchas referencias bibliográficas, la osteonecrosis de los sesamoideos del pie debe ser considerada en el diagnóstico diferencial de la metatarsalgia persistente

A 37-year-old man presented with forefoot pain presentwith walking. The pain was located in the plantar zone of the first metatarsophalangeal joint. Plain film radiographs revealed fragmentation and heterogeneous sclerosis. Magnetic resonance imaging confirmed the diagnosis of avascular necrosis of the medial sesamoid. He was treated conservatively with metatarsal padding and nonsteroidal anti-inflammatory medications. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistentforefoot pain

Drenaje venoso pulmonar parcial derecho. Síndrome de la cimitarra / no disponible

No disponible

Calcificación distrófica postraumática aislada de músculo sartorio / Post-traumatic dystrophic calcification isolated from the sartorius muscle

Presentamos un caso de calcificación distrófica muscular tras traumatismos repetidos y revisamos las diferentes causas de calcificaciones de partes blandas y de osificación heterotópica

We present a case of muscular dystrophic calcification after repeated traumas and review the different cases of calcifications of the soft parts and heterotopic ossification

Necrosis avascular de cabeza femoral tras osteosíntesis de fractura pertrocantérea con clavo gamma / Avascular necrosis of the femoral head after gamma nailing of a intertrochanteric fracture

Presentamos el caso de una paciente con fractura pertrocantérea del fémur y que, un año después de ser tratada con un «clavo gamma» y de evolucionar favorablemente, desarrolló una necrosis avascular de la cabeza femoral. Se discute su posible patogenia y se concluye recomendando una buena técnica de fijación quirúrgica para evitar el proceso y pensar en esta posibilidad cuando los resultados clínicos de un paciente que había experimentado un buen resultado se deterioren tardíamente

This is a case study of a patient with a intertrochanteric femoral fracture treated by gamma nailing with favourable evolution for a period of one year that subsequently developed avascular necrosis of the femoral head. The possible cause is discussed and a good surgical fixation technique is recommended to prevent this outcome. It is advisable to consider this condition as a possible explanation for the long-term deterioration of a patient with good initial postoperative clinical results

Tricobezoar. Una causa rara de dolor abdominal con apariencia radiológica típica / Trichobezoar. A rare cause of abdominal pain with typical X-ray appearance

Un bezoar es una masa compuesta por material extraño ingerido, normalmente fibras vegetales o pelos, en el interior del tubo digestivo. Los tricobezoares son raros y aparecen normalmente en individuos con trastornos mentales. Presentamos una paciente de 16 años, con trastornos emocionales, que consulta por dolor abdominal, vómitos de dos días de evolución y masa en cuadrantes abdominales superiores. Se realiza radiografía convencional, ecografía y tomografía computarizada de abdomen que ponen de manifiesto los signos radiológicos típicos de tricobezoar gástrico. Hacemos especial hincapié en la utilidad de la tomografía computarizada en el diagnóstico preoperatorio y en la detección de posibles complicaciones. La paciente fue tratada mediante laparotomía, gastrotomía y extracción del tricobezoar. El postoperatorio discurrió sin complicaciones y actualmente está en tratamiento por psiquiatría

A bezoar is a ball of swallowed foreign material that is usually vegetable fibers or hairs, in the digestive tract. Trichobezoars are rare and normally appear in individuals with mental disorders. We present the case of a 16 year old woman with emotional disorders who consulted due to abdominal pain, two-day long vomiting and mass in upper abdominal quadrant. A plain X-ray, ultrasonography and CT scan of the abdomen were performed. They showed typical X-ray signs of gastric trichobezoar. We emphasize the utility of the CT scan in the preoperative diagnosis and in the detection of possible complications. The patient was treated by laparatomy, gastrotomy and extraction of the trichobezoar. Post-operative period was without complications and she is currently receiving psychiatric treatment

Apendicitis epiploica / Epiploic appendicitis

No disponible

Síndrome de Paget-Schroetter / Paget-Schroetter syndrome

No disponible

Cistitis enfisematosa. Valor de las pruebas de imagen / Cystitis emphysematous. The role of imaging studies

La cistitis enfisematosa es una complicación rara de la infección del tracto urinario, que se caracteriza por la presencia de gas intravesical y en la pared de la vejiga urinaria, debida a la fermentación bacteriana. Aproximadamente el 50-80% de los pacientes es diabético y hay una mayor incidencia en mujeres. Los hallazgos clínicos en esta entidad son inespecíficos y normalmente las pruebas de imagen (radiografía simple, ecografía y/o tomografía computarizada) confirman el diagnóstico. Se comentan los hallazgos en cada una de ellas. La tomografía computarizada es la prueba radiológica más sensible para detectar el proceso, ya que permite la detección temprana de aire vesical intramural, intraluminal, así como la demostración de otras causas de gas vesical o intrapelviano, y es capaz de detectar las posibles complicaciones. Un diagnóstico temprano es la clave para un tratamiento correcto de esta afección

Emphysematous cystitis is a rare complication of urinary tract infection, characterized by spontaneous gas presentation in the urinary bladder due to bacterial fermentation. Approximately 50 to 80% of patients with this disease are diabetic, and there is a higher incidence in females. This clinical entity is associated with urinary retention too, like neurogenic bladder dysfunction or outlet obstruction. Clinical and physical findings are not specific in emphysematous cystitis, and the diagnosis is usually first suspected by radiologic exams ­conventional radiography, US or CT. The finds in each one of them will be commented. The CT is both highly sensitive and specific examination, that allows early detection of intramural or intraluminal urinary bladder gas. It is also useful in evaluating other causes of urinary bladder or pelvis abnormal gas, and possible complications. An early diagnosis is the key for a correct management of this pathology