Gas-containing ganglia of the hip

A case of rheumatoid arthritis with bilateral shoulder bursitis accompanied by gas image

We experienced a case of bilateral shoulder bursitis with gas images in a rheumatoid arthritis (RA) patient. A 60-year-old man with RA had been treated with weekly methotrexate 10 mg and daily prednisolone (PSL) 10 mg for 7 months. Generalized pain, especially in the bilateral shoulder joints, developed and exacerbated daily with increased C-reactive protein (CRP) level. Despite the initiation of biweekly sarilumab 200 mg, joint symptoms and CRP level continued to worsen. Computed tomography (CT) scan to determine the cause of severe shoulder inflammation revealed low absorption areas with contrast effects at the margins around the bilateral shoulder joints, accompanied by internal gas images. In addition, magnetic resonance imaging demonstrated subacromial bursae and coracoid bursae and bursitis, leading to the suspicion of abscess formation depending on the presence of gas image. In spite of antimicrobial therapy, arthralgia did not improve, and a CT-guided arthrocentesis of the left shoulder joint resulted in negative findings of infection in culture and pathological examinations. Switching treatment to intensive anti-inflammatory therapy with high-dose steroids and etanercept finally improved symptoms and CRP levels associated with the reduction of low absorption areas and disappearance of gas images at bilateral shoulder joints. Our case indicated that bursitis with gas image in RA patients involves unusual pathophysiology and requires intensive anti-rheumatic treatment.

Gas-containing iliopsoas bursitis in the setting of degenerative osteoarthritis

This is a case of a 77-year-old woman with a 4.0 cm gas-containing iliopsoas bursa collection in the setting of mild-to-moderate degenerative joint disease. Given the limited extent of this patient's osteoarthritis and the absence of infectious signs or symptoms, both of which are typically related to gas collections at the hip, it was difficult to determine the aetiology of the patient's gas collection, whether it was related to her pain, and how best to manage her symptoms. Even in the setting of her MRI findings, which showed the gas collection lifting the iliopsoas tendon off the bone, the gas-containing bursa ultimately appeared to be a minor component of the patient's pain and definitive treatment of her underlying joint disease with a total hip arthroplasty allowed for successful pain management. Our case report demonstrates an unusual presentation of iliopsoas bursitis with a surprising response to medical, interventional and surgical management.

Incidence of Vacuum Phenomenon Related Intra-articular or Subfascial Gas Found on Computer-Assisted Tomography (CT) Scans of Closed Lower Extremity Fractures

OBJECTIVES

To determine the incidence of vacuum phenomenon related intra-articular or subfascial gas found on computer-assisted tomography (CT) scans of closed lower extremity fractures.

DESIGN

Retrospective Review.

SETTING

Level I Trauma Center.

PATIENTS/PARTICIPANTS

A total of 153 patients with closed lower extremity fractures.

INTERVENTION

CT scans of identified individuals were reviewed for the presence or absence of gaseous accumulations.

MAIN OUTCOME MEASUREMENTS

The presence or absence of gas on CT.

RESULTS

Twenty seven (17.6%) of the 153 fractures were found to have intra-articular or subfascial gas on CT despite clear documentation, indicating a closed injury with no significant skin compromise. Of the intra-articular fractures (OTA/AO 33B/C, 41B/C and 43B/C), 20% (23 of 113) were found to have gas on CT. All cases were associated with fracture of the tibia (P = 0.002).

CONCLUSIONS

Computed tomography demonstrated the presence of intra-articular or subfascial gas in 17.6% (27/153) of closed lower extremity fractures and in 20% (23/113) of closed intra-articular fractures. The possibility of vacuum phenomenon must be considered when using this imaging modality as the confirmatory test for open intra-articular fracture or traumatic arthrotomy.

LEVEL OF EVIDENCE

Level IV.

Gas-Containing Paralabral Ganglion Cyst of the Shoulder: A Case Report

CASE

A thirty-three-year-old woman presented with right shoulder pain and moderate atrophy of the infraspinatus muscle, with grade-4 (of 5) external rotation strength. Magnetic resonance imaging showed a gas-containing ganglion cyst. Surgical excision and arthroscopic evaluation were performed. The extra-articular arthroscopic view of the ganglion showed bubbles within the mucous material. One year after surgery, she had pain-free, normal range of motion and normal strength of the affected shoulder.

CONCLUSION

We report a rare case of a gas-containing ganglion cyst that originated in the posterosuperior glenohumeral capsule and caused entrapment of the suprascapular nerve.

Musculoskeletal pitfalls and pseudotumours in the pelvis: a pictorial review for body imagers

Many musculoskeletal abnormalities in the pelvis are first seen by body imagers while reviewing pelvic cross-sectional studies, and some of these abnormalities may mimic malignancy or another aggressive process. This article describes nine musculoskeletal pseudotumours and interpretative pitfalls that may be seen on CT, MRI and ultrasound imaging of the pelvis. Awareness of these pitfalls and pseudotumours may help avoid misdiagnosis and prevent inappropriate intervention or management.

Femoral nerve compression secondary to a ganglion cyst arising from a hip joint: a case report and review of the literature

Introduction

Femoral nerve compression due to a cystic lesion around the hip joint is rare and only a few cases have been described in the literature. Among these, true ganglion cysts are even more rare.

Case presentation

We report the case of a 57-year-old woman with femoral nerve compression caused by a true ganglion cyst of the hip joint.

Conclusion

A high index of suspicion is required to predict a non-palpable cystic lesion around the hip joint as it may mimic different disorders and should be kept in mind in the differential diagnosis of unusual groin pain, radicular pain and peripheral vascular disorders.

Subperiosteal ganglion associated with Paget's disease of bone

Tumoral lesions related to Paget's disease may be classified as malignant, benign or pseudotumoral. While sarcomatous degeneration is the most feared complication, awareness of benign and pseudotumoral lesions is essential for assisting in accurate histological interpretation of the biopsy sample, which may avoid unnecessary repeat biopsies. We present the first case of a juxta-articular subperiosteal ganglion associated with Paget's disease, with classic imaging characteristics, especially on CT examination. The well-defined soft tissue mass at the medial aspect of the obturator rim, adjacent to a small fracture in pagetic quadrilateral plate, showed an ossified rim and internal gas lucencies, these being the hallmarks of a juxta-articular subperiosteal ganglion. On MRI, the lesion was of intermediate signal intensity on T1-weighted sequences, increased signal intensity on T2-weighted sequences, with rim enhancement after gadolinium contrast injection and preservation of fatty marrow signal of the underlying pagetic bone. Identification of the entity avoided an unnecessary biopsy or surgical intervention.

Atypical retroperitoneal extension of iliopsoas bursitis

We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures.

Intraosseous pneumatocyst of the scapula

Intraosseous pneumatocyst is a gas-containing cyst-like lesion that occurs most frequently in the ilium, sacrum or vertebrae. We present a case involving the left scapula that was found incidentally on CT. To our knowledge, intraosseous pneumatocyst of the scapula has not been previously reported.

Ganglion of the hip joint--we present a logical approach to the exploration of a mass in the femoral triangle

Hip joint ganglion is a rare cause of a mass in the femoral triangle. Our patient presented with a swelling in the groin and a history of femoral hernia repair 5 years previously. Pre-operative assessment with ultrasound suggested a possible femoral artery aneurysm. We propose that safe exploration of a mass closely related to the femoral vessels must include vascular control.