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Li B, Liu Q, Chen X, Chen T, Dang W, Zhao J, Cui G, Chen K, Wu Y. A Novel Idiopathic Atrial Calcification: Pathologic Manifestations and Potential Mechanism. Front Cardiovasc Med 2022; 9:788958. [PMID: 35387434 PMCID: PMC8978529 DOI: 10.3389/fcvm.2022.788958] [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] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac calcification is a type of ectopic pathologic calcification of unknown etiology and mechanisms. Once diagnosed, the location, extent and morphology of the calcified lesions, as well as their functional significance in the heart, are usually the focus of case reports. Calcification is mostly distributed in myocardium, but rarely reported in atrium. In addition, because of limited sampling and complex pathological mechanisms, the etiology underlying the formation of these calcified lesions also remains unclear. Methods Two cardiac calcifications were found in a patient, died of trauma-induced subarachnoid hemorrhage after slightly drinking, during a standard autopsy. The location and morphological characteristics of the calcified lesions were determined by computed tomography (CT) and CT-based 3D reconstruction. The specific histopathological characteristics of the lesions were determined by multi-staining. The concentration of free calcium and inorganic pyrophosphate (PPi) in plasma reflected the change of calcium metabolism. The expression and membranal localization of the ATP Binding Cassette Subfamily C Member 6 (ABCC6) in hepatocytes were detected by immunofluorescence. The variants of the ABCC6 were detected by Sanger sequencing and potential pathogenic variants were further identified by in silico analysis. Results The present study describes a patient with idiopathic calcification with two pear-shaped and irregularly hollow lesions symmetrically distributed in the patient's atrium. Massive accumulation of calcium salts was identified by multi-staining. For this patient, the plasma concentration of free calcium was higher than the control, indicating that calcium metabolism was disturbed. Furthermore, the plasma PPi of the patient was lower than the normal. By using immunofluorescence, the expression and membranal localization of ABCC6 was decreased and impaired in hepatocytes, respectively. Combined with Sanger sequencing and in silico analysis, 7 variants were identified. Conclusions This study described a novel patient with symmetrically distributed idiopathic atrial calcifications. Furthermore, all the results indicated that these pathologic calcifications may be secondary to reduced plasma PPi content due to ABCC6 dysfunction in hepatocytes. Moreover, these findings provided novel clues to the pathogenesis, clinical diagnosis and treatment of idiopathic atrial calcification in future.
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Affiliation(s)
- Bowen Li
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Qingbo Liu
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Xihui Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Tangdong Chen
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Wenhui Dang
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Jing Zhao
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
| | - Guangbin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, Xi'an, China
- Guangbin Cui
| | - Kun Chen
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, Air Force Medical University, Xi'an, China
- Kun Chen
| | - Yuanming Wu
- Department of Biochemistry and Molecular Biology, Air Force Medical University, Xi'an, China
- Shaanxi Junda Forensic Medicine Expertise Station, Air Force Medical University, Xi'an, China
- *Correspondence: Yuanming Wu
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Navarro-Hortal MD, Ramírez-Tortosa CL, Varela-López A, Romero-Márquez JM, Ochoa JJ, Ramírez-Tortosa MC, Forbes-Hernández TY, Granados-Principal S, Battino M, Quiles JL. Heart Histopathology and Mitochondrial Ultrastructure in Aged Rats Fed for 24 Months on Different Unsaturated Fats (Virgin Olive Oil, Sunflower Oil or Fish Oil) and Affected by Different Longevity. Nutrients 2019; 11:E2390. [PMID: 31591312 PMCID: PMC6835383 DOI: 10.3390/nu11102390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 12/18/2022] Open
Abstract
Diet plays a decisive role in heart physiology, with lipids having especial importance in pathology prevention and development. This study aimed to investigate how dietary lipids varying in lipid profile (virgin olive oil, sunflower oil or fish oil) affected the heart of rats during aging. Heart histopathology, mitochondrial morphometry, and oxidative status were assessed. Typical histopathological features associated with aging, such as valvular lesions, endomyocardical hyperplasia, or papillary muscle calcification, were found at a low extent in all the experimental groups. The most relevant finding was that inflammation registered by fish oil group was lower compared to the other treatments. At the ultrastructural level, heart mitochondrial area, perimeter, and aspect ratio were higher in fish oil-fed rats than in those fed on sunflower oil. Concerning oxidative stress markers, there were differences only in coenzyme Q levels and catalase activity, lower in sunflower oil-fed animals compared with those fed on fish oil. In summary, dietary intake for a long period on dietary fats with different fatty acids profile led to differences in some aspects associated with the aging process at the heart. Fish oil seems to be the fat most protective of heart during aging.
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Affiliation(s)
- María D Navarro-Hortal
- Department of Physiology, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
| | - César L Ramírez-Tortosa
- UGC de Anatomía Patológica, Hospital San Cecilio de Granada, Avda, Conocimiento s/n, 18100 Granada, Spain.
| | - Alfonso Varela-López
- Department of Physiology, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
| | - José M Romero-Márquez
- Department of Physiology, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
| | - Julio J Ochoa
- Department of Physiology, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
| | - MCarmen Ramírez-Tortosa
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
| | - Tamara Y Forbes-Hernández
- Nutrition and Food Science Group, Department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo, 36310 Vigo, Spain.
| | - Sergio Granados-Principal
- UGC de Oncología Médica, Hospital Universitario de Jaén, Avenida del Ejército Español 10, 23007 Jaén, Spain.
- Genyo, Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada-Avenida de la Ilustración 114, 18016 Granada, Spain.
| | - Maurizio Battino
- Nutrition and Food Science Group, Department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo, 36310 Vigo, Spain.
- Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche-Sez. Biochimica, Università Politecnica delle Marche, Ancona, 60131 Ancona, Italy.
- International Research Center for Food Nutrition and Safety, Jiangsu University, 212013 Zhenjiang, China.
| | - José L Quiles
- Department of Physiology, Institute of Nutrition and Food Technology "José Mataix Verdú", Biomedical Research Center, University of Granada, Avda del Conocimiento sn., 18100 Armilla, Granada, Spain.
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Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging 2019; 10:83. [PMID: 31428880 PMCID: PMC6702502 DOI: 10.1186/s13244-019-0761-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | - Michael Bolen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Maybrook RJ, Afzal MR, Parashar S, Deibert B, Chivington M, Walker JY, Dawn B, Parashara D. Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature. Echocardiography 2015; 33:117-32. [DOI: 10.1111/echo.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ryan J. Maybrook
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Muhammad R. Afzal
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Sonya Parashar
- University of Kansas School of Medicine; Kansas City Kansas
| | - Brent Deibert
- University of Kansas School of Medicine; Kansas City Kansas
| | - Mary Chivington
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Jacquelyn Y. Walker
- Division of Cardiology; VA Eastern Kansas Health Care System; Leavenworth Kansas
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Deepak Parashara
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
- Division of Cardiology; Kansas City VA Medical Center; Kansas City Missouri
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Nance JW, Crane GM, Halushka MK, Fishman EK, Zimmerman SL. Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings. J Cardiovasc Comput Tomogr 2015; 9:58-67. [DOI: 10.1016/j.jcct.2014.10.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/09/2014] [Accepted: 10/12/2014] [Indexed: 01/13/2023]
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Kim EJ, Song BG, Sohn HR, Hong SM, Park DW, Heo SH, Kim KY, Cho WH, Choi SK. Senile Cardiac Calcification Syndrome: A Rare Case of Extensive Calcification of Left Ventricular Papillary Muscle. Cardiol Res 2011; 2:127-129. [PMID: 28352380 PMCID: PMC5358317 DOI: 10.4021/cr29w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 11/05/2022] Open
Abstract
Extensive papillary muscle calcification is uncommon and only scarce literature about causes and the clinical significance is available, whereas small calcific deposits are common findings in elderly people and are located most commonly at the apex. Papillary muscle calcification has been associated with coronary artery disease, dilated cardiomyopathy, mitral valve disease, hypercalcemia, and increased calcium phosphate product in end stage renal disease. We reported a rare case of extensive calcification of anterolateral papillary muscle diagnosed by echocardiography and multidetector computed tomography.
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Affiliation(s)
- Eun Jin Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Bong Gun Song
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Hyung Rae Sohn
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Su-Min Hong
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Seung Hye Heo
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Kye Yeon Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Wook-Hyun Cho
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Suk-Koo Choi
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
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Tanimoto T, Imanishi T, Kitabata H, Nakamura N, Kimura K, Yamano T, Ishibashi K, Komukai K, Ino Y, Takarada S, Kubo T, Hirata K, Mizukoshi M, Tanaka A, Akasaka T. Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction. Circulation 2010; 122:2281-7. [DOI: 10.1161/circulationaha.109.935338] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Tanimoto
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Imanishi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuo Nakamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Keizo Kimura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kohei Ishibashi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kenichi Komukai
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shigeho Takarada
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kumiko Hirata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masato Mizukoshi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Pagel PS, Murphy RM, Iqbal Z, Gandhi SD, Markan S. Why the "Y"? A peculiar intraventricular structure associated with a posterior basal aneurysm. Diagnosis: isolated calcification of the distal posterior medial papillary muscle. J Cardiothorac Vasc Anesth 2008; 23:118-20. [PMID: 18834758 DOI: 10.1053/j.jvca.2007.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA.
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Jackowski C, Schweitzer W, Thali M, Yen K, Aghayev E, Sonnenschein M, Vock P, Dirnhofer R. Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI. Forensic Sci Int 2005; 149:11-23. [PMID: 15734105 DOI: 10.1016/j.forsciint.2004.05.019] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 05/31/2004] [Indexed: 10/26/2022]
Abstract
The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.
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Affiliation(s)
- Christian Jackowski
- Institute of Forensic Medicine, University of Bern, IRM-Buehlstrasse 20, CH-3012 Bern, Switzerland.
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Abstract
Cardiac calcification usually represents the result of a pathologic process. Some forms of calcification represent chronic change in an ageing population, and must be differentiated from pathologic calcification. Still other forms of calcification are associated with ageing and chronic degeneration, but also reflect ongoing pathologic processes. Recognition of cardiac calcification may be an early sign or only sign of a pathologic process. Characterization of the calcification in terms of its distribution and appearance is a helpful means for determining which structures are calcified, differentiating pathologic from nonpathologic processes. This article provides an overview of the types of calcifications of the heart, pathogenesis, and utility of the various imaging modalities for their detection.
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Affiliation(s)
- Ramesh M Gowda
- The Heart Institute of Beth Israel Medical Center, New York, NY 10003, USA
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Beyth S, Liebergall M, Mosheiff R. Myositis ossificans circumscripta of the sacrotuberous ligament: a case report and review of the literature. J Orthop Trauma 2002; 16:672-4. [PMID: 12368649 DOI: 10.1097/00005131-200210000-00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soft tissue ossification is a well-known phenomenon in various pathologic conditions. Myositis ossificans circumscripta refers to posttraumatic calcification of soft tissue, including various ligaments. However, posttraumatic calcification of ligaments in the pelvis is a rare complication described only anecdotally in the past. We present a rare case of posttraumatic calcification of the sacrotuberous ligament in a patient, several months after suffering a pelvic trauma. This is one of the differential diagnoses of soft tissue pain and tenderness after trauma.
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Affiliation(s)
- Shaul Beyth
- Orthopedic Surgery Department, Hadassah Medical Center, Ein Kerem, Jerusalem, Israel
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