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Vidal Leão R, Fernandes Batista Pereira R, Omena Martins R, Sayuri Yamachira V, Tokechi Amaral D, Ejnisman L, de Paula Correa MF, Partezani Helito PV. Imaging evaluation of hip capsule disorders: a comprehensive review. Skeletal Radiol 2024:10.1007/s00256-024-04766-5. [PMID: 39096373 DOI: 10.1007/s00256-024-04766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
The hip capsule and capsular ligaments play crucial roles in providing hip stability and mobility. Their role in hip pathologies is being increasingly recognized, underscoring the need for thorough imaging evaluation, which is better performed through MRI-arthrography. Various diseases affect the hip capsule directly or indirectly. Improper mechanical loading, as seen in conditions such as femoroacetabular impingement or chondrolabral pathology, can induce capsule thickening, whereas thinning and laxity of the capsule are characteristics of microinstability. Inflammatory conditions, including adhesive capsulitis of the hip, crystal deposition disease, polymyalgia rheumatica, and infections, also lead to capsular changes. Traumatic events, particularly posterior hip dislocations, cause capsule ligament disruption and may lead to hip macroinstability. Friction syndromes can lead to capsular edema due to impingement of the adjacent capsule. Hip arthroscopy can result in various postoperative findings ranging from fibrotic adhesions to focal or extensive capsule discontinuation. Although the significance of hip capsule thickness and morphology in the pathogenesis of hip diseases remains unclear, radiologists must recognize capsule alterations on imaging evaluation. These insights can aid clinicians in accurately diagnosing and effectively managing patients with hip conditions.
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Affiliation(s)
- Renata Vidal Leão
- Musculoskeletal Division, University of Iowa Hospitals and Clinics, Iowa, IA, USA.
| | | | - Raul Omena Martins
- Radiology Department, Hospital Sírio-Libanês, R Adma Jafet, São Paulo, 101, Brazil
| | | | | | - Leandro Ejnisman
- Institute of Orthopaedics and Traumatology, Av. Albert Einstein, 627/701, Morumbi, São Paulo, Brazil
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Picasso R, Zaottini F, Pistoia F, Macciò M, Rossi G, Cabona C, Benedetti L, Martinoli C. High-resolution ultrasound and magnetic resonance imaging of ulnar nerve neuropathy in the distal Guyon tunnel. Insights Imaging 2023; 14:210. [PMID: 38015304 PMCID: PMC10684459 DOI: 10.1186/s13244-023-01545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The aim of the present study is to describe the ultrasound (US) and magnetic resonance imaging (MRI) findings in patients with neuropathies affecting the deep (DB) and superficial (SB) branches of the Ulnar nerve (UN) and to investigate the potential role of imaging modalities in the diagnostic workup of these conditions. MATERIALS AND METHODS We screened our institutional imaging database to identify patients with a diagnosis of UN mononeuropathy, and among them, we reviewed the cases where US disclosed pathological findings affecting the UN terminal divisions. In this latter subgroup, we retrieved available data on MRI and electrodiagnostic tests performed by the patients during the diagnostic workup. All the patients were evaluated with US machines equipped with 17-5-MHz, 18-4-MHz, 24-8-MHz, or 22-8-MHz probes. MRI exams were performed on a 3-T unit equipped with a 64-channel head RF coil. RESULTS Among 166 patients with UN mononeuropathy, we retrieved 15 patients (9%) for which US detected pathological findings affecting the UN terminal divisions, consisting of 7 cases of DB neuropathy, 4 cases of SB neuropathy, and 4 cases of combined neuropathy involving both nerves. Seven (46.7%) patients were submitted to MRI to integrate US findings. Among patients with SB and DB neuropathies, imaging allowed the identification of 7 traumatic nerve injuries, 2 nerve tumors, and 6 entrapment neuropathies, including 4 cases of nerve compression by a ganglion cyst. CONCLUSION High-resolution US and MRI are accurate modalities for the investigation of patients with SB/DB neuropathy, can provide critical information on the cause of nerve damage, and guide therapeutic decisions. CRITICAL RELEVANCE STATEMENT High-resolution US and MRI are accurate modalities for the investigation of patients with superficial/deep branch of the ulnar nerve neuropathy. In the proper setting, US may be regarded as a first-line approach in patients with suspected neuropathies affecting these small branches. KEY POINTS • Neuropathies affecting the distal ulnar nerve often require multimodal investigations. • US and MRI can provide detailed morphological information about the terminal branches of the ulnar nerve. • US may be considered as a first-line approach in suspected distal ulnar nerve neuropathies.
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Affiliation(s)
- Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy.
| | - Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy
| | - Marta Macciò
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
| | - Gabriele Rossi
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
| | - Corrado Cabona
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy
| | - Luana Benedetti
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa, Italy
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
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Fana M, Deamont C, Medani K, Manjila R, Kandregula S, Labarge III D, Manjila S. Retro-Odontoid Intradural Synovial Cyst Decompression via Endoscopic-Assisted Far-Lateral Approach C1-C2 Hemilaminectomy Without Fusion: The Use of Intracranial Denticulate Ligament as Intraoperative Landmark. Cureus 2022; 14:e21715. [PMID: 35242480 PMCID: PMC8885175 DOI: 10.7759/cureus.21715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
Abstract
Purely intradural retro-odontoid synovial cysts are rarely reported in neurosurgical literature, particularly in the absence of associated bony erosions. We present the case of a 57-year-old Native American male with a retro-odontoid synovial cyst and a history of chronic refractory neck pain that was adequately decompressed via an endoscopic-assisted far-lateral approach using a C1-2 hemilaminectomy, obviating the vertebral artery (VA) transposition, bony instability, and the need for instrumented bony fusion. The patient presented to our clinic with several months of refractory nuchal and cervical spine pain and crepitation affecting his activities of daily living (ADL). MRI findings revealed an intradural cyst at the level of C2 behind the odontoid process impinging on the medulla and causing early VA displacement. Both stereotactic neuro-navigation and microsurgical visualization aided in the manipulation of the endoscope and attaining the caudocranial working trajectory. The patient remained neurologically non-lateralizing postoperatively, similar to his preoperative status. This article highlights a less invasive surgical exposure with an endoscope-assisted caudocranial trajectory obtained by a limited unilateral hemilaminectomy to achieve the desired outcome.
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Gokhale S, Mullaney P, Thomas P, Carpenter EC. Hip pain attributable to a ganglion of the psoas tendon: a common cyst in an uncommon region-the first case reported in a child. BMJ Case Rep 2021; 14:e244520. [PMID: 34697088 PMCID: PMC8547365 DOI: 10.1136/bcr-2021-244520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/04/2022] Open
Abstract
Ganglion cysts of the psoas tendon are uncommon and rarely reported in the literature. Often they remain asymptomatic and are found incidentally or can be a cause of atypical groin/hip pain. We present a rare case of ganglion cyst in a child arising from the psoas tendon, causing symptomatic hip pain, which failed non-surgical treatment and eventually successfully treated with surgical excision.
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Affiliation(s)
- Sandeep Gokhale
- Trauma and Orthopaedics, University hospital of Wales healthcare NHS trust, Cardiff, UK
| | | | - Phillip Thomas
- Trauma and Orthopaedics, University hospital of Wales, Cardiff, UK
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Allison CM, Bonanos G, Varma A. Bilateral ganglion cysts at L4/5 causing central canal stenosis and producing sciatica and neurogenic claudication: a case report. Ann R Coll Surg Engl 2021; 104:e41-e43. [PMID: 34414791 DOI: 10.1308/rcsann.2021.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.
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Affiliation(s)
- C M Allison
- James Cook University Hospital, Middlesbrough, UK.,Newcastle University Medical School, Newcastle upon Tyne, UK
| | - G Bonanos
- James Cook University Hospital, Middlesbrough, UK
| | - A Varma
- James Cook University Hospital, Middlesbrough, UK
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Ait Ichou J, Gauvin S, Faingold R. Ultra-high-frequency ultrasound of superficial and musculoskeletal structures in the pediatric population. Pediatr Radiol 2021; 51:1748-1757. [PMID: 33666733 DOI: 10.1007/s00247-021-04978-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
Because of its relatively low cost, lack of ionizing radiation and great versatility, US is considered the imaging modality of choice to evaluate a large variety of pediatric conditions. Imaging of superficial structures and small anatomical parts can be at times limited with standard US. Recent advances in technology yielded ultra-high-frequency US systems that are capable of scanning with frequencies as high as 70 MHz and resolutions of 30 μm. This technology, approved by the United States Food and Drug Administration, has not been widely used in the clinical setting. It has the potential to become a powerful diagnostic tool in clinical practice, especially in the evaluation of infants, given their inherent body habitus. Our main objective is to discuss the use of ultra-high-frequency US at a tertiary care center. This pictorial essay presents a gamut of pediatric pathologies pertaining to imaging of the soft tissues and the superficial and musculoskeletal structures. Our aim in this pictorial essay is to highlight and illustrate the role of ultra-high-frequency US in improving the depiction of common and less common pathologies. We think it also helps to gain a new understanding of the normal anatomy in the pediatric population and to display specific features not shown by standard US and, in certain cases, ones that lead to a change in diagnosis.
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Affiliation(s)
- Jamal Ait Ichou
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Simon Gauvin
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Ricardo Faingold
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.,Department of Diagnostic Radiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Percutaneous ultrasound-guided ganglion fenestration in children: initial results. Skeletal Radiol 2021; 50:1169-1175. [PMID: 33156396 DOI: 10.1007/s00256-020-03662-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate our pediatric experience with percutaneous ultrasound-guided fenestration of ganglia (PUGG). MATERIALS AND METHODS Retrospective study of pediatric patients who underwent PUGG from June 2016 to October 2018 at a free-standing tertiary referral academic children's hospital with a minimum of 6 months follow-up. Electronic medical records, picture archiving system, and post-procedural calls were utilized for patient demographics, lesion characteristics, procedure details, and recurrence. The procedure itself consisted of assessment by Child Life, application of topical anesthetic cream, sterile preparation and draping, and intra-procedural ultrasound guidance for local anesthetic instillation, ganglion aspiration, fenestration, and intra-remnant steroid instillation. Post-procedure care included an ice pack, compression dressing for 48 h, and 4 weeks of brace wear and activity restriction. RESULTS Forty-five patients met the inclusion criteria, ages 3-18 years, mean 13.5 years, and female to male ratio of 2:1. Ganglion locations consisted of 80% (36/45) in the wrist and 20% (9/45) in other locations (elbow, ankle, and foot). Ninety-eight percent (44/45) of procedures were performed non-sedated, including 20% (9/44) between ages 7 and 11 years. 28.9% (13/45) of ganglia recurred, the earliest at 3 weeks, the latest at 10 months, and an average of 3 months' time. No complication occurred and no patients required post-procedural narcotics or Emergency Department visitation for pain control. CONCLUSION Percutaneous ultrasound-guided fenestration of ganglia (PUGG) is a safe, minimally invasive alternative to surgical excision in the pediatric population, which can be performed without sedation and does not leave a scar.
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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Anaya JEC, Coelho SRN, Taneja AK, Cardoso FN, Skaf AY, Aihara AY. Differential Diagnosis of Facet Joint Disorders. Radiographics 2021; 41:543-558. [PMID: 33481690 DOI: 10.1148/rg.2021200079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Spinal pain due to facet joint disease is difficult to diagnose since the clinical history and physical examination findings are usually nonspecific. Facet joint disorders have a wide range of causes and, because of the potential for chronic back pain and disability, an accurate diagnosis is essential. The most frequent cause of pain in facet joints is osteoarthritis, which can be assessed at radiography, CT, or MRI. Ganglion and synovial cysts of the facet joints can cause compressive symptoms of adjacent structures, especially radiculopathy, lower back pain, and sensory or motor deficits. In ankylosing spondylitis, imaging findings of the facet joints are useful not only for diagnosis but also for monitoring structural changes. In septic arthritis of the facet joints, an early diagnosis at MRI is essential. Gout and metabolic diseases are best evaluated at dual-energy CT, which allows the depiction of crystals. Traumatic dislocations of facet joints are usually unstable injuries that require internal reduction, fixation, and fusion and can be well assessed at CT with three-dimensional reconstructions. Facet joint neoplasms like osteoid osteoma, plasmacytoma, tenosynovial giant cell tumor, and osteochondroma are best evaluated at CT or MRI. The authors provide an overview of key imaging features of the most common facet joint disorders along with anatomic tips and illustrative cases. Acknowledging key imaging findings for the differential diagnosis of facet joint disorders plays a crucial role in the diagnostic accuracy and proper treatment approach for such entities. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Julia E C Anaya
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Silmara R N Coelho
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Atul K Taneja
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Fabiano N Cardoso
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Abdalla Y Skaf
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - André Y Aihara
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
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Velagapudi L, Matias CM, Elia C, Stolzenberg D, Largoza G, Feld R, Curtis M, Harrop JS. Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential. Spinal Cord Ser Cases 2021; 7:6. [PMID: 33468998 DOI: 10.1038/s41394-020-00373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy. CASE PRESENTATION A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5-S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst. DISCUSSION While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.
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Affiliation(s)
- Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Caio M Matias
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Elia
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Stolzenberg
- Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rick Feld
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark Curtis
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
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Giant intraosseous ganglion of the fibula: multimodality imaging. Skeletal Radiol 2020; 49:2063-2067. [PMID: 32524167 DOI: 10.1007/s00256-020-03489-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Intraosseous ganglia around the knee are most commonly located in the proximal tibia and limited to the epiphyseal-metaphyseal region. We report the case of a giant intraosseous ganglion of the fibula. MRI demonstrated the fluid avascular content of the lesion. CT arthrography of the knee demonstrated partial opacification of the lesion through a cortical bone defect. The lesion was treated with curettage and bone grafting. Anatomopathological examination confirmed the medical imaging diagnosis of intraosseous ganglion. This case highlights the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the ganglion.
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Nys M, Verstraete L, Van Camp N, Hermans R, Politis C. Synovial and ganglion cysts of the temporomandibular joint: A case series. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Intramuscular Ganglion Cyst of the Flexor Hallucis Brevis Secondary to Muscle Tear: A Case Report. Diagnostics (Basel) 2020; 10:diagnostics10070484. [PMID: 32708727 PMCID: PMC7399892 DOI: 10.3390/diagnostics10070484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
In the current study, we present a case of an intramuscular ganglion cyst in the flexor hallucis brevis muscle (FHB) that arose secondary to a muscle tear. Through this study, we propose a possible aetiology for the development of intramuscular ganglionic cysts. A 50-year-old woman presented with acute pain and swelling over the right mid-plantar area after prolonged kneeling for scrubbing floors. Ultrasonography examination performed at 5 days after the onset of symptoms revealed a partial tear of the right FHB. Follow-up evaluations were conducted, with magnetic resonance imaging and ultrasonography, at 24 and 54 days after symptom onset. MRI revealed a ganglion cyst in the mid-portion of the FHB without connection to the adjacent joint capsule or tendon sheath. On the ultrasonography examination at 45 days after onset, at the same location where a tear was seen on the initial examination, an anechoic defect in the mid-portion of the FHB was observed, compatible with a ganglion cyst. Given the favourable natural evolution, no aspiration or surgery were performed. The patient was discharged with minimal symptoms. The results suggest that the intramuscular ganglion cyst can develop following a muscle tear.
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Veselis CA, Awan O, Thomas A, Ling S, Jonnalagadda P, Aneja A, Ali S. Bone Tumors Occurring in the Soft Tissues: A Review of the Clinical, Imaging, and Histopathologic Findings. Curr Probl Diagn Radiol 2020; 50:419-429. [PMID: 32665061 DOI: 10.1067/j.cpradiol.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 12/16/2022]
Abstract
Although rare in everyday practice, malignancies that classically arise from bone or cartilage have been reported to arise de novo in various soft tissues in the body, resulting in a diagnostic challenge for the clinician, radiologist, and pathologist. Differential diagnoses of bone tumors often depend on anatomic location of the lesion. For example, the classic location of osteosarcoma is in the metaphysis of long bones about the knee. Histologically osteosarcoma is characterized by tumor cells that directly produce osteoid, bone, or cartilaginous matrix. In extraskeletal osteosarcoma, the clinical and radiologic picture is very different from a conventional osteosarcoma. They occur in older patients, present as a soft tissue mass often coincidentally following trauma and have a worse prognosis. The imaging characteristics are often nonspecific with mineralized elements in a well-defined soft tissue mass. The mineralized elements may or may not be visible. Magnetic Resonance sequences demonstrate a well circumscribed soft tissue mass with hemorrhagic and enhancing solid components. The pathologic features of extraskeletal osteosarcoma on a microscopic scale are identical to that of skeletal lesions. Likewise, conventional chondrosarcomas present in older patients with a growing, painful soft tissue prominence most commonly involving the long tubular bones. In extraskeletal chondrosarcoma however, the presentation is in somewhat younger patients with a painful soft tissue prominence typically in the head (meninges), neck, or upper leg. The pathologic features are most often that of a myxoid chondrosarcoma which is characterized by strands of small cells over a myxoid matrix. Imaging features include chondroid matrix, heterogenous contrast enhancement, and amorphous internal calcification on Computed Tomography. On Magnetic Resonance sequences the matrix has a low signal on all sequences, and variable inhomogeneity depending on grade of the lesion. Other extraskeletal bone tumors include Ewing's sarcoma and osteoid osteoma amongst other lesions. Although these malignancies may be rare clinical entities, they often exhibit characteristic clinical, imaging, and histopathological findings although differing in treatment and prognosis. Knowledge of these and other common mimicking lesions will help guide the clinician and radiologist to make an accurate diagnosis.
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Affiliation(s)
| | - Omer Awan
- University of Maryland School of Medicine. Baltimore, MD
| | | | | | | | | | - Sayed Ali
- Temple University Hospital. Philadelphia, PA
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Min SK, Han A, Min S, Park YJ. Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards. Vasc Specialist Int 2020; 36:57-65. [PMID: 32611837 PMCID: PMC7333088 DOI: 10.5758/vsi.200029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.
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Affiliation(s)
- Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Obturator Internus Synovial Cyst: A Rare Cause of Posterior Hip Pain. Am J Phys Med Rehabil 2020; 99:e134-e135. [PMID: 32167954 DOI: 10.1097/phm.0000000000001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Trojani MC, Arrigoni PP, Le Goff B. Prevalence and characteristics of proximal tibiofibular joint cysts on MRI. Joint Bone Spine 2020; 87:97-98. [DOI: 10.1016/j.jbspin.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
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18
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Yamasaki Y, Tezuka F, Yamashita K, Takata Y, Sakai T, Maeda T, Sairyo K. Multiple Loose Bodies in the Lumbar Facet Joint: Case Report. NMC Case Rep J 2019; 6:79-81. [PMID: 31417836 PMCID: PMC6692599 DOI: 10.2176/nmccrj.cr.2017-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4–L5 level, and loose bodies in the left L4–L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4–L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient’s symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.
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Affiliation(s)
- Yuhei Yamasaki
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
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Titelbaum AR, Ibarra Asencios B, McNeil BE. A circular depression at the spinoglenoid notch of a prehistoric Andean scapula: Plausible evidence of suprascapular nerve entrapment by a paralabral cyst. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 24:19-24. [PMID: 30245228 DOI: 10.1016/j.ijpp.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 06/08/2023]
Abstract
While intraosseous cysts have been described in the paleopathological literature, it is rare to find reports concerning effects of soft tissue cysts, although they are relatively common in clinical contexts. Here we present plausible evidence of an extraosseous paralabral cyst, seen in an adult scapula from a Late Intermediate period commingled tomb (ca. AD 1200) at the northern highland site of Marcajirca, Ancash, Peru. The scapula demonstrated a smooth-sided concave depression at the spinoglenoid notch. The depression was notable for its regular appearance, with no bone deposition or destruction. Rather than reflect an intraosseous pathology, the defect likely resulted from pressure erosion from a space-occupying mass. A narrow strip of flattened bone connected the depression to the posterior-superior aspect of the glenoid. The location and morphology of the depression and its connection with the glenoid are consistent with the effects of a paralabral cyst that arose secondary to a tear of the posterior-superior glenoid labrum. A labral tear may act as a one-way valve permitting fluid to flow along a path of least resistance, often to the spinoglenoid notch. A cyst at the spinoglenoid notch would compress the suprascapular nerve, causing weakened function of infraspinatus and its eventual atrophy.
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Affiliation(s)
- Anne R Titelbaum
- Basic Medical Sciences, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85004, USA.
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Vidoni A, Sankara STV, Ramana V, Botchu R. Ganglion cyst arising from the transverse acetabular ligament (TAL): a rare cause of entrapment of the anterior branch of the obturator nerve. Case report and review of the literature. Skeletal Radiol 2019; 48:163-165. [PMID: 29876592 DOI: 10.1007/s00256-018-2992-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/13/2018] [Accepted: 05/25/2018] [Indexed: 02/02/2023]
Abstract
The transverse acetabular ligament is an unusual location for ganglion cysts. Only a few cases have been reported in the literature. They can be asymptomatic and represent an incidental finding or can cause an atypical pattern of hip joint/groin pain. We report a case of ganglion cyst arising from the TAL causing entrapment of the anterior branch of the obturator nerve with associated acute denervation of the abductor longus (AL), adductor brevis (AB), and gracilis muscles.
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Affiliation(s)
- Alessandro Vidoni
- MSK Radiology Department, Cardiff & Vale University Health Board, Cardiff, UK.
| | | | | | - Rajesh Botchu
- Msk Radiology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Lee JY, Kang BS, Shim HS, Song IH, Kim M, Lee SH, Chung HW, Lee MH, Shin MJ. Clear Cell Hidradenoma: Characteristic Imaging Features on Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1993-2001. [PMID: 29388236 DOI: 10.1002/jum.14552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/01/2017] [Accepted: 11/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the imaging features of clear cell hidradenoma on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). METHODS The radiologic and pathologic databases at 2 medical institutions were searched retrospectively from 2004 to 2016 to identify patients with a diagnosis of clear cell hidradenoma. Ultrasonographic, CT, and MRI features were described, and pathologic specimens were reviewed. RESULTS There were 5 female and 4 male patients. The mean patient age was 48.9 years (range, 28-70 years). Five patients underwent only US; 2 patients underwent only CT; 1 patient underwent both US and CT; and 1 patient underwent US and MRI. Most of the tumors were located primarily in the subcutaneous fat layer. The mean tumor size was 18.4 mm. On US, 6 masses had a heterogeneous echo texture, including an anechoic portion with protruding echogenic portions. Two masses had multiple septa in the anechoic portion. On color Doppler US, blood flow was both central and peripheral in 5 patients. All 3 cases seen on CT presented as a low-attenuation mass with an enhanced solid internal nodule. On MRI, the mass showed heterogeneous signal intensity on T2-weighted images and enhancement of the peripheral wall and internal solid component on contrast-enhanced T1-weighted images. CONCLUSIONS Clear cell hidradenoma is usually located in the subcutaneous fat layer, has a well-defined margin, appears as a cystic mass with an internal solid nodule, and occasionally has multiple septa on US, CT, and MRI.
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Affiliation(s)
- Joo Yeon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byeong Seong Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Hyun Seok Shim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - In Hye Song
- Department of Pathology , University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Misung Kim
- Department of Pathology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sang Hoon Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung Jin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lesions involving the outer surface of the bone in children: a pictorial review. Insights Imaging 2016; 7:763-778. [PMID: 27761882 PMCID: PMC5110481 DOI: 10.1007/s13244-016-0527-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/18/2016] [Accepted: 09/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background Lesions involving the outer cortical surface of the bone occur quite often among children. Broadly, these include benign cortical, juxtacortical and periarticular lesions, dysplasias affecting the cortical bone, regional and diffuse periosteal pathology and malignant tumours. Some of these lesions are unique to the paediatric population; others are more frequently seen among children than adults — yet others have an adult predilection but can occasionally be seen in children. Methods A complete list of differential considerations for lesions involving the outer cortical surface of the bone in children is presented. Imaging characteristics on plain film radiography and MR are described in association with multiple examples and illustrations. Conclusion A pictorial review detailing the imaging features of surface lesions of the bone in children will be a useful aide for both radiologists and their clinical colleagues, and will help them sort their way through the maze of differential diagnoses for these abnormalities. Teaching Points • Surface lesions of bones in children comprise a distinct entity and differ from those in adults. • Imaging plays an important role towards classifying surface lesions of bones in children. • MRI features may be characteristic and aid precise diagnosis, thus guiding further management.
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