Complejo agnatia-otocefalia / Agnathia-otocephaly complex

El complejo agnatia-otocefalia es una malformación letaly muy infrecuente que puede ser diagnosticada medianteecografía de alta resolución. Describimos el caso de estaentidad en la que la ecografía reveló polihidramnios, cámara gástrica reducida y malformaciones faciales como agnatia, sinotia y protuberancia de la fusión nasobucal

Agnathia-otocephaly complex is a very unfrequentand lethal malformation that could be diagnosed by realtime ultrasonography. We report a case of prenatal diagnosis of this fetal malformation in which the ultrasound examination revealed polyhhidramnios, small stomach shadow and fetal face malformations like agnathia and a protuberance of the nose-mouth fusion

Trastorno de la coordinación uterina. Inversión del triple gradiente descendente / Uncoordinated uterine activity. Inversion of the triple descending gradient

Se describe el caso de una gestante que en 2 ocasiones y de forma consecutiva presentó, poco antes del término, una actividad uterina descoordinada sin modificaciones cervicales y que fue diagnosticada de distocia dinámica por inversión del “triple gradiente de contracción”. Desde los años cincuenta se conoce su existencia, pero nunca se había podido explicar la causa de este fenómeno. A través de la revisión bibliográfica se analizan las posibles causas y los distintos tratamientos empleados en su resolución

We describe the case of a pregnant woman who, on two consecutive occasions and shortly before term, presented uncoordinated uterine activity without cervical modification and who was diagnosed with dynamic dystocia due to inversion of the “triple contraction gradient”. This phenomenon has been known since the 1950s but its cause has never been explained. We performed a literature review to analyze its possible causes and the various treatments used to resolve it

Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients.

OBJECTIVE: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. PATIENTS AND DESIGN: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. RESULTS: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. CONCLUSION: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain.

Superior labral anteroposterior lesions: MR arthrography with arm traction.

OBJECTIVE: The purpose of this study was to investigate the efficacy of arm traction combined with MR arthrography in the evaluation of superior labral anteroposterior (SLAP) lesions. MATERIALS AND METHODS: Cadaveric shoulders were studied with a 1.5-T MR imaging unit with the arm externally rotated. Fifteen milliliters of a gadolinium-containing contrast agent were injected into the glenohumeral joint. Twenty-four sets of images of cadaveric joints were evaluated independently by two observers. These sets consisted of MR arthrographic images obtained with traction (applied to the wrist using 1- to 3-kg weights) and without traction in five shoulders in which SLAP lesions had been excluded arthroscopically or by cadaveric sectioning; and MR arthrographic images obtained with and without traction in seven shoulders in which various types of SLAP lesions had been created arthroscopically and later confirmed by cadaveric sectioning. RESULTS: Analysis of the data indicated that MR arthrography in combination with arm traction and external rotation improved diagnostic accuracy with regard to identification and categorization of SLAP lesions when compared with studies made without traction. CONCLUSION: The combination of MR arthrography and arm traction with the shoulder in external rotation provides a more effective approach for detection of SLAP lesions than does similar MR arthrography performed without arm traction.

Bicipitoradial bursitis: MR imaging findings in eight patients and anatomic data from contrast material opacification of bursae followed by routine radiography and MR imaging in cadavers.

PURPOSE: To use radiography and magnetic resonance (MR) imaging after contrast material opacification of the bursae in cadaveric specimens to demonstrate the anatomy of the bicipitoradial bursa and to report MR imaging findings in patients with bicipitoradial bursitis. MATERIALS AND METHODS: Bicipitoradial bursa in eight cadaveric elbows were injected with a solution containing gadodiamide, iodinated contrast agent, and gelatin. Radiographs and MR images were obtained in each specimen, with both supination and pronation of the forearm. The morphology and relationships of the bursa were studied. Anatomic sections subsequently were obtained. MR imaging studies in eight patients with bicipitoradial bursitis were also evaluated. RESULTS: The bicipitoradial bursa revealed a smooth outline and a wide base along the superficial aspect of the radius. The mean volume of contrast material that could be injected before extravasation was 4 mL. The mean size of the bursa was 1.8 x 2.5 cm. The bicipitoradial bursa enveloped the biceps tendon, with internal septation seen in two cases. Displacement of the superficial branch of the radial nerve by the bursa was found in two specimens. Communication between the bicipitoradial bursa and elbow joint was not observed. In patients, MR imaging demonstrated fluid collections in the bicipitoradial bursa in all cases, with compression of branches of the radial nerve in two cases. CONCLUSION: The anatomy of the bicipitoradial bursa is demonstrated with radiography and MR imaging of bursae. MR imaging allows accurate diagnosis of bicipitoradial bursitis and its effects on adjacent structures.

Effect of a patellar realignment brace on patients with patellar subluxation and dislocation. Evaluation with kinematic magnetic resonance imaging.

The object of this study was to evaluate the effect of a patellar realignment brace on patients with patellar subluxation or dislocation. Twenty-one patients (24 patellofemoral joints) with clinical evidence of patellar subluxation (N = 16) or dislocation (N = 5) were examined with the joint inside a positioning device to allow active-motion, kinematic magnetic resonance imaging. To analyze the patellar tracking pattern, the same imaging parameters (patellar tilt angle, bisect offset, and lateral patellar displacement) and section locations were used before and after application of a patellar realignment brace. No statistically significant differences were found in any of the three parameters for the patellofemoral relationships before or after wearing the patellar brace. The results indicated no stabilizing effect of the tested brace in patients with patellar subluxation or dislocation during active joint motion.

Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts.

OBJECTIVE: The purpose of this study is to describe MR imaging features of an unusual type of meniscal cyst arising from tears of the posterior horn of the medial meniscus in 10 patients. MATERIALS AND METHODS: Retrospective review of MR examinations of the knee was performed of 10 patients (nine men, one woman; mean age, 39 years) in whom evidence of a meniscal tear and a cyst-like structure around the posterior cruciate ligament (PCL) was seen. RESULTS: An oval mass with low signal intensity on T1-weighted MR images and increased signal intensity on T2-weighted MR images posterior to the PCL, simulating a PCL ganglion cyst, was seen in all 10 patients. A tear of the posterior horn of the medial meniscus was also seen in all patients. The sites of communication between the cyst and meniscal tear were observed in sagittal MR images in eight patients. Septation within the cyst and associated joint effusion were seen in eight and four patients, respectively. Arthroscopy in eight patients and transmeniscal needle drainage in the other two patients confirmed both the meniscal tear and the pericruciate meniscal cyst. CONCLUSION: Pericruciate meniscal cysts cause fluid collections posterior to the PCL, simulating a PCL ganglion cyst. Careful analysis of the posterior horn of the medial meniscus should be performed when a cyst-like structure is seen adjacent to the PCL.

Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation.

OBJECTIVE: Conventional radiography, arthrography, CT arthrography, and MR arthrography--including use of the abduction and external rotation position--were compared, with arthroscopic correlation, to determine the spectrum of abnormalities encountered and the relative benefits of each imaging method in the evaluation of shoulder lesions occurring in 17 throwing athletes. SUBJECTS AND METHODS: Each of 36 athletes with shoulder pain aggravated by abduction and external rotation was examined in a single visit during which conventional radiography, arthrography, CT arthrography, and MR arthrography were performed. In 17 of these athletes, imaging findings were compared with those at arthroscopy. All images were independently evaluated by two groups of musculoskeletal radiologists. RESULTS: Structures found to be affected were, in decreasing order of frequency, the following: the posterosuperior labrum, supraspinatus tendon, infraspinatus tendon, humeral head, glenoid cavity and rim, acromioclavicular joint, anteroinferior capsulolabral complex, biceps tendon, and subscapularis tendon. MR arthrography without and with abduction and external rotation yielded the highest sensitivity and specificity for all lesions with the exceptions of bone sclerosis and enthesophytes (which were best seen with CT arthrography). MR arthrography with abduction and external rotation was most accurate for diagnosis of rotator cuff and anteroinferior capsulolabral complex tears. CONCLUSION: On the basis of these preliminary results, we believe that MR arthrography with abduction and external rotation should be part of the imaging evaluation of shoulder pain in throwing athletes, owing to the high sensitivity of this imaging technique.

Collateral ligaments of the ankle: high-resolution MR imaging with a local gradient coil and anatomic correlation in cadavers.

Findings at high-resolution magnetic resonance (MR) imaging of the lateral and medial collateral ligaments of the ankle were compared with findings in anatomic sections from cadavers. MR imaging of six cadaveric feet was performed with a newly developed local gradient coil and axial and coronal T1-weighted spin-echo sequences. Axial imaging provided optimum views of the anterior and posterior talofibular ligaments, the deep layers of the medial collateral ligament, and the tibionavicular ligament. Coronal imaging allowed complete visualization of the calcaneofibular, posterior talofibular, tibiocalcaneal, and posterior tibiotalar ligaments. In both imaging planes, differentiation of the deep and superficial layers of the medial collateral ligament was possible. Differentiation between the syndesmotic complex and the lateral collateral ligament was accomplished easily; in particular, differentiation of the posterior tibiofibular ligament from the posterior talofibular ligament was not difficult because of the differing insertions of these ligaments. The inhomogeneous appearance of the medial collateral ligament and the posterior talofibular ligament on MR images correlated with areas of fatty tissue on corresponding microscopic sections. High-resolution MR imaging with a newly developed local gradient coil allows excellent visualization of the lateral and medial collateral ligaments of the ankle.

Evaluation of articular cartilage thickness of the humeral head and the glenoid fossa by MR arthrography: anatomic correlation in cadavers.

OBJECTIVE: To evaluate the accuracy of MR arthrography in determining the thickness of articular cartilage of the humeral head and glenoid fossa. DESIGN AND PATIENTS: MR arthrography of the glenohumeral joint was performed in 17 cadaveric shoulders. Articular cartilage thickness was measured on the MR arthrographic images and corresponding anatomic sections. RESULTS: The correlation coefficients for MR arthrographic measurement versus anatomic measurement of the cartilage thickness were 0.7324 and 0.8757 for humeral head and glenoid fossa, respectively. With regard to the humeral head, there was a tendency to overestimate regions of thin cartilage and underestimate regions of thick cartilage. This tendency was not found in the assessment of glenoid cartilage. The mean of the absolute value of MR-anatomic differences was similar on the glenoid side (0.27 mm) and the humeral side (0.29 mm). The accuracy of measurement was significantly better on the glenoid side (Fisher's r-to-Z transformation: Z=5.21, P=0.000001). CONCLUSION: MR arthrography causes a moderate degree of error in the naked-eye measurement of the cartilage of the glenohumeral joint. The accuracy is higher on the glenoid side than on the humeral side.