Dorsalis pedis psuedoaneurysm: A complication followed extensor tendoscopy of the ankle in a non-tuberculosis patient with tenosynovitis with rice body formation

Rice body synovitis in systemic lupus erythematosus

Rice bodies (RBs) synovitis in the shoulder joints of systemic lupus erythematosus patients is a rare clinical condition that has not been previously reported. Despite the fact that the diagnosis of RBs synovitis has primarily relied on MRI imaging, ultrasound has been used less frequently. In this report, we discuss a 43-year-old female diagnosed with systemic lupus erythematosus who presented with pain and swelling in the right shoulder. The ultrasound findings were typical, and the patient was diagnosed with RBs synovitis, as she had no history of tuberculosis or rheumatoid arthritis. Subsequently, the patient underwent ultrasound-guided percutaneous biopsy and surgical excision, which led to a good postoperative outcome. Based on this case, a literature review of RBs synovitis over the past 2 decades indicates that rice bodies synovitis is rare in clinical presentation accompanied by SLE. Moreover, ultrasound has not been extensively employed for diagnosing this condition. It is important to note the pivotal role of ultrasound in detecting RBs synovitis, and it should be the preferred method for early detection. Therefore, ultrasound physicians should be well informed about this condition to enhance diagnostic precision.

Endoscopic En-Bloc Resection of Lipoma of the Tibialis Anterior Tendon

Lipoma is benign soft-tissue tumor that consists entirely of mature fat and can occur in a superficial or deep location. Lipoma of the foot and ankle can even develop within a tendon sheath or joint. Classically, lipoma is resected via open approach, which may result in a lengthy disfiguring surgical scar. Endoscopic en-bloc tumor resection is a minimally invasive approach and can provide a whole block specimen for histologic examination. The purpose of this Technical Note is to describe the details of endoscopic en-bloc resection of lipoma of the tibialis anterior tendon.

Candida parapsilosis-Caused Arthritis with Rice Body Formation: A Case Presentation and Literature Review

A 68-year-old male patient came to the orthopedics department because of swelling and pain in his left shoulder joint. He received more than 15 intraarticular steroid injections in the shoulder joint at a local private hospital. MRI showed that the synovial membrane of the joint capsule was thickened and swollen, and there were extensive "rice body-like" low T2 signal shadows filling. Arthroscopic removal of rice bodies and subtotal bursectomy were performed. The observation channel was placed through the posterior approach, and a large amount of rice bodies in yellow bursa fluid were observed to flow out. Rice bodies with a diameter of approximately 1-5 mm filled the joint cavity were seen in the observation channel. The histopathological examination of the rice body showed that it was mainly composed of fibrin without a clear tissue structure. Bacterial and fungal cultures of synovial fluid suggested Candida parapsilosis infection, so the patient received antifungal treatment. However, the shoulder swelled again after three weeks, MRI revealed that there was significant fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating and ultrasound examination showed joint cavity effusion, synovial hyperplasia, and some synovium looked like "floating weeds". After 2 weeks, there were recurrent rice bodies in the articular cavity. Arthroscopic surgery was performed again to clean the joint and a catheter was placed for irrigation and drainage, and a large amount of necrotic synovial tissue floating as seen in ultrasound. Finally, patient received sensitive antifungal treatment and did not relapse within 6 months. During the recurrence in the current case, we recorded the process of rice body formation, which has for the first time been reported.

Rice bodies in a shoulder bursa: a cadaveric and histologic case report

INTRODUCTION

The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature.

METHODS

A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment.

RESULTS

The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes.

CONCLUSIONS

Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.

True aneurysm of the dorsalis pedis artery

OBJECTIVES

Aneurysm of the pedal arteries is uncommon. I present a case of non-traumatic fusiform true aneurysm of the dorsalis pedis artery in an otherwise well 45-year-old man. Color flow duplex imaging revealed aneurysmal dilation, involving all layers of the artery wall, measuring 16.5 * 10 mm with irregular intraluminal thrombus across a 6.33-mm segment. Due to concerns over embolization, our patient underwent successful ligation of the dorsalis pedis artery. He had an uneventful post-operative recovery.

METHODS

Case report.

RESULTS

No postoperative complication or signs of ischemia.

CONCLUSIONS

Treatment of asymptomatic dorsalis pedis artery aneurysm may be of value to prevent risk of thrombo-embolic complications, foot ischemia, or rupture without warning signs. Patency of the pedal arch is important to avoid foot ischemia in case of dorsalis pedis artery ligation.

Hundreds of rice bodies in the subacromial-subdeltoid bursa: report of two cases and literature review

Background

Multiple rice bodies (RB) in the shoulder joint is a rare disorder of unknown etiology that requires percutaneous drainage or surgical operation.

Case presentation

We reported arthroscopic removal of hundreds of RB in the subacromial-subdeltoid bursa in two cases by our “chopsticks technique”. One was associated with seropositive rheumatoid arthritis and the other was a rare synovial origin possibly due to microinfarction and ischemia after the radiotherapy. Radical debridement of necrotic tissue, “red tissue” and synovitis by arthroscopic radiofrequency ablation was essential for eliminating the cause of RB. A favorable clinical evolution was observed for both patients.

Conclusions

We highlight the importance of patient-specific differential diagnosis and the clinical course of RB to help us further understand the pathogenesis of this uncommon disorder. Meanwhile, evacuation of RB and “red tissue” ablation by arthroscopy showed good results.

Pseudoaneurysm following ankle arthroscopy: a systematic review of case series

BACKGROUND/OBJECTIVE

Pseudoaneurysms (PA) are rare complications following ankle arthroscopy (AA). Delay in diagnosis is reported to be frequent and could lead to serious complications. Evidence synthesis on the clinical context of such complication lacks in the literature.

METHODS

A systematic review is conducted to locate all relevant papers. In total, 23 case reports were included in the review. Data of 23 patients with a mean of 40.9 ± 10.3 years were extracted and analyzed. Outcomes included comorbidities, portals and procedure types performed during AA, PA location and size, time to diagnosis and treatment, and therapeutic modalities.

RESULTS

The results showed that d-ATA and the dorsal pedis artery (DPA) were involved in 18 and 4 cases, respectively. A single case of PA of the fibular artery was described. The mean PA size was found to be 4.2 × 3.9 × 2.1 cm. Five of the 14 patients (35.7%) with a reported detailed medical history were treated for a cardiovascular or hemostasis condition. Delay in PA diagnosis was found to be at a mean time of 50.45 ± 74.6 days. The most commonly reported surgical indications were anterior synovectomy and removal of anterior osteophytes. Ligation was the most common procedure in treating PA.

CONCLUSION

While portal placement might be a minor factor, the variability of the d-ATA and/or DPA anatomical position and its affection with foot position and distraction during AA could play a role in the arterial injury. Synovectomy and removal of anterior, particularly big-sized, osteophytes could be considered as risk factors as well. A state of hypocoagulability might affect injury healing and consequently PA formation. PA diagnosis should be raised whenever a non-resolving or pulsatile swelling over a portal incision is observed.

Should the Histological Examination Be Used in the Diagnosis of Aneurysms of the Dorsalis Pedis Artery? A Case Report and Review of the Literature

Aneurysms of the dorsalis pedis artery are rare, and they are not commonly examined histologically. In general, pseudoaneurysms are thought to be more common than true aneurysms of the dorsalis pedis artery. We present a patient with a true aneurysm of the dorsalis pedis artery, which was initially diagnosed as a pseudoaneurysm that had developed because of a blunt trauma of the ankle. However, the intraoperative appearance and histological examination both confirmed a true aneurysm. Our experiences seem to confirm that postoperative histological examination is needed to distinguish pseudoaneurysms from true aneurysms of the dorsalis pedis artery. The treatment of aneurysms of the dorsalis pedis artery is simple and includes resection, which completely relieves the symptoms; few patients need vascular reconstructions.

Endoscopic Resection of the Tibialis Anterior Tendon Bursa

The tibialis anterior tendon bursa is located between the tibialis anterior tendon and the medial cuneiform bone and close to the tendon insertion. Bursitis can occur as a result of excessive local friction, infection, arthritides, or direct trauma. Endoscopic resection of the bursa is indicated in case of symptomatic bursitis that is not responding to conservative treatment or infection is suspected. It is contraindicated if there is skin infection at the portal sites. The purpose of this technical note is to describe a minimally invasive approach of endoscopic resection of the tibialis anterior tendon bursa through anterior tibial tendoscopy.