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Fat misbehaving in the abdominal cavity: a pictorial essay. Pol J Radiol 2020; 85:e32-e38. [PMID: 32180852 PMCID: PMC7064015 DOI: 10.5114/pjr.2020.93070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022] Open
Abstract
Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.
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Peterson JR, De La Rosa S, Eboda O, Cilwa KE, Agarwal S, Buchman SR, Cederna PS, Xi C, Morris MD, Herndon DN, Xiao W, Tompkins RG, Krebsbach PH, Wang SC, Levi B. Treatment of heterotopic ossification through remote ATP hydrolysis. Sci Transl Med 2016; 6:255ra132. [PMID: 25253675 DOI: 10.1126/scitranslmed.3008810] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heterotopic ossification (HO) is the pathologic development of ectopic bone in soft tissues because of a local or systemic inflammatory insult, such as burn injury or trauma. In HO, mesenchymal stem cells (MSCs) are inappropriately activated to undergo osteogenic differentiation. Through the correlation of in vitro assays and in vivo studies (dorsal scald burn with Achilles tenotomy), we have shown that burn injury enhances the osteogenic potential of MSCs and causes ectopic endochondral heterotopic bone formation and functional contractures through bone morphogenetic protein-mediated canonical SMAD signaling. We further demonstrated a prevention strategy for HO through adenosine triphosphate (ATP) hydrolysis at the burn site using apyrase. Burn site apyrase treatment decreased ATP, increased adenosine 3',5'-monophosphate, and decreased phosphorylation of SMAD1/5/8 in MSCs in vitro. This ATP hydrolysis also decreased HO formation and mitigated functional impairment in vivo. Similarly, selective inhibition of SMAD1/5/8 phosphorylation with LDN-193189 decreased HO formation and increased range of motion at the injury site in our burn model in vivo. Our results suggest that burn injury-exacerbated HO formation can be treated through therapeutics that target burn site ATP hydrolysis and modulation of SMAD1/5/8 phosphorylation.
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Affiliation(s)
- Jonathan R Peterson
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sara De La Rosa
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Oluwatobi Eboda
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Katherine E Cilwa
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD 20910, USA
| | - Shailesh Agarwal
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Steven R Buchman
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Paul S Cederna
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA. Section of Plastic Surgery, Department of Biomedical Engineering, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Michael D Morris
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch at Galveston, and Shriners Hospitals for Children, Galveston, TX 77550, USA
| | - Wenzhong Xiao
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Paul H Krebsbach
- Department of Biologic and Material Sciences, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Stewart C Wang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Chung SB, Muradov JM, Lee SH, Eoh W, Kim ES. Uncovertebral hypertrophy is a significant risk factor for the occurrence of heterotopic ossification after cervical disc replacement: survivorship analysis of Bryan disc for single-level cervical arthroplasty. Acta Neurochir (Wien) 2012; 154:1017-22. [PMID: 22421919 DOI: 10.1007/s00701-012-1309-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/13/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the incidence of heterotopic ossification (HO) in the Bryan cervical arthroplasty group and to identify associations between preoperative factors and the development of HO. METHODS We performed a retrospective review of clinical and radiological data on patients who underwent single-level cervical arthroplasty with Bryan prosthesis between January 2005 and September 2007. Patients were postoperatively followed-up at 1, 3, 6, 12 months and every year thereafter. The clinical assessment was conducted using Odom's criteria. The presence of HO was evaluated on the basis of X-ray at each time-point according to the McAfee classification. In this study, we focused on survivorship of Bryan prosthesis for single-level arthroplasty. The occurrence of ROM-affecting HO was defined as a functional failure and was used as an endpoint for determining survivorship. RESULTS Through the analysis of 19 cases of Bryan disc arthroplasty for cervical radiculopathy and/or myelopathy, we revealed that ROM-affecting HO occurs in as many as 36.8% of cases and found that 37% of patients had ROM-affecting HO within 24 months following surgery. The overall survival time to the occurrence of ROM-affecting HO was 36.4 ± 4.4 months. Survival time of the prosthesis in the patient group without preoperative uncovertebral hypertrophy was significantly longer than that in the patient group with preoperative uncovertebral hypertrophy (47.2 months vs 25.5 months, p = 0.02). Cox regression proportional hazard analysis illustrated that preoperative uncovertebral hypertrophy was determined as a significant risk factor for the occurrence of ROM-affecting HO (hazard ratio = 12.30; 95% confidential interval = 1.10-137.03; p = 0.04). CONCLUSION These findings suggest that the condition of the uncovertebral joint must be evaluated in preoperative planning for Bryan cervical arthroplasty.
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Affiliation(s)
- Sang-Bong Chung
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
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Bone in the belly: traumatic heterotopic mesenteric ossification. Emerg Radiol 2012; 19:429-36. [PMID: 22527357 DOI: 10.1007/s10140-012-1042-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
Heterotopic mesenteric ossification is an unusual but important complication in patients who sustain blunt and penetrating abdominal trauma. In this condition, bone formation occurs in the mesenteric and omental fat in response to injury and may result in serious complications such as bowel obstruction and fistula formation. Although a few case reports exist, the radiology literature on this topic is scant. Based on our experience, this entity is under-recognized on imaging studies and often results in diagnostic confusion due to its resemblance to other pathologies such as barium leak and extraskeletal bone-forming neoplasms. This review highlights the imaging features of heterotopic mesenteric ossification with an emphasis on computed tomographic findings. Radiologist awareness of this condition is crucial to avoid misdiagnosis as well as to direct appropriate and timely management.
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Postoperative Bowel Perforation due to Heterotopic Ossification (Myositis Ossificans Traumatica): A Case Report and Review of the Literature. Case Rep Gastrointest Med 2011; 2011:908514. [PMID: 22606429 PMCID: PMC3350174 DOI: 10.1155/2011/908514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/03/2011] [Indexed: 11/17/2022] Open
Abstract
Heterotopic ossification (HO) is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.
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