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Zandee van Rilland ED, Yao L, Stevens KJ, Chung LS, Fiorentino DF, Boutin RD. Myositis and Its Mimics: Guideline Updates, MRI Characteristics, and New Horizons. AJR Am J Roentgenol 2024. [PMID: 38838235 DOI: 10.2214/ajr.24.31359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Myositis is defined as inflammation within skeletal muscle and is a subcategory of myopathy, which is more broadly defined as any disorder affecting skeletal muscle. Myositis may be encountered as a component of autoimmune and connective tissue disease, where it is described as idiopathic inflammatory myopathy. Myositis can also be caused by infections, as well as toxins and drugs, including newer classes of medications. MRI plays an important role in the diagnosis and evaluation of patients with suspected myositis, but many entities may have imaging features similar to myositis and can be considered myositis mimics. These include muscular dystrophies, denervation, deep venous thrombosis, diabetic myonecrosis, muscle injury, heterotopic ossification, and even neoplasms. In patients with suspected myositis, definitive diagnosis may require integrated analysis of imaging findings with clinical, laboratory, and pathology data. The objectives of this article are to review the fundamental features of myositis, including recent updates in terminology and consensus guidelines for idiopathic inflammatory myopathies, the most important MRI differential diagnostic considerations for myositis (i.e., myositis mimics), and new horizons, including the potential importance of artificial intelligence and multimodal integrated diagnostics in the evaluation of patients with muscle disorders.
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Affiliation(s)
- Eddy D Zandee van Rilland
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305
| | - Lawrence Yao
- Radiology and Imaging Sciences, NIH Clinical Center, 10 Center Drive, MSC 1182, Bethesda, Maryland 20892
| | - Kathryn J Stevens
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305
| | - Lorinda S Chung
- Department of Medicine (Immunology and Rheumatology), Stanford University School of Medicine and Palo Alto VA Health Care System, 300 Pasteur Drive, Stanford, CA 94305
| | - David F Fiorentino
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305
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2
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Brands SR, Nawijn F, Foppen W, Hietbrink F. No role for standard imaging workup of patients with clinically evident necrotizing soft tissue infections: a national retrospective multicenter cohort study. Eur J Trauma Emerg Surg 2024; 50:875-885. [PMID: 38253724 PMCID: PMC11249592 DOI: 10.1007/s00068-023-02414-6] [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] [Received: 05/11/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE To assess the diagnostic contribution of different imaging studies to diagnose necrotizing soft tissue infections (NSTIs) and the time to surgery in relation to imaging with the hypothesis that imaging studies may lead to significant delays without being able to sufficiently dismiss or confirm the diagnosis since a NSTI is a surgical diagnosis. METHODS A retrospective multicenter cohort study of all NSTI patients between 2010 and 2020 was conducted. The primary outcome was the number of cases in which imaging contributed to or led to change in treatment. The secondary outcomes were time to treatment determined by the time from presentation to surgery and patient outcomes (amputation, intensive care unit (ICU) admission, length of ICU stay, hospital stay, and mortality). RESULTS A total of 181 eligible NSTI patients were included. The overall mortality was 21% (n = 38). Ninety-eight patients (53%) received imaging in the diagnostic workup. In patients with a clinical suspicion of a NSTI, 81% (n = 85) went directly to the operating room and 19% (n = 20) underwent imaging before surgery; imaging was contributing in only 15% (n = 3) by ruling out or determining underlying causes. In patients without a clinical suspicion of a NSTI, the diagnosis of NSTI was considered in 35% and only after imaging was obtained. CONCLUSION In patients with clinically evident NSTIs, there is no role for standard imaging workup unless it is used to examine underlying diseases (e.g., diverticulitis, pancreatitis). In atypical presenting NSTIs, CT or MRI scans provided the most useful information. To prevent unnecessary imaging and radiation and not delay treatment, the decision to perform imaging studies in patients with a clinical suspicion of a NSTI must be made extremely careful.
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Affiliation(s)
- Sanne R Brands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Femke Nawijn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Pal D, Roy SG, Singh R, Hayeri MR. Imaging features of soft-tissue infections. Skeletal Radiol 2024:10.1007/s00256-024-04694-4. [PMID: 38702530 DOI: 10.1007/s00256-024-04694-4] [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: 09/10/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.
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Affiliation(s)
- Devpriyo Pal
- North Bengal Medical College, Siliguri, West Bengal, India
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4
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Sabir N, Akkaya Z. Musculoskeletal infections through direct inoculation. Skeletal Radiol 2024:10.1007/s00256-024-04591-w. [PMID: 38291151 DOI: 10.1007/s00256-024-04591-w] [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: 07/31/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings.
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Affiliation(s)
- Nuran Sabir
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey.
| | - Zehra Akkaya
- Department of Radiology, Faculty of Medicine, İbni Sina Hospital, Ankara University, Ankara, Turkey
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5
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Matcuk GR, Skalski MR, Patel DB, Fields BKK, Waldman LE, Spinnato P, Gholamrezanezhad A, Katal S. Lower extremity infections: Essential anatomy and multimodality imaging findings. Skeletal Radiol 2024:10.1007/s00256-024-04567-w. [PMID: 38244060 DOI: 10.1007/s00256-024-04567-w] [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: 07/24/2023] [Revised: 09/23/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
In modern practice, imaging plays an integral role in the diagnosis, evaluation of extent, and treatment planning for lower extremity infections. This review will illustrate the relevant compartment anatomy of the lower extremities and highlight the role of plain radiographs, CT, US, MRI, and nuclear medicine in the diagnostic workup. The imaging features of cellulitis, abscess and phlegmon, necrotizing soft tissue infection, pyomyositis, infectious tenosynovitis, septic arthritis, and osteomyelitis are reviewed. Differentiating features from noninfectious causes of swelling and edema are discussed.
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Affiliation(s)
- George R Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste M-335, Los Angeles, CA, 90048, USA.
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic - West Campus, San Jose, CA, 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Brandon K K Fields
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Leah E Waldman
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Ali Gholamrezanezhad
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste M-335, Los Angeles, CA, 90048, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
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6
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de Almeida CÁ, Nakamura R, Leverone A, Costa F, Estrada BD, Haui P, Luz F, Yamada AF, Werner H, Canella C. Imaging features for the evaluation of skin and nail infections. Skeletal Radiol 2024:10.1007/s00256-023-04557-4. [PMID: 38194095 DOI: 10.1007/s00256-023-04557-4] [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: 07/27/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.
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Affiliation(s)
- Carolina Ávila de Almeida
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil.
| | - Robertha Nakamura
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreia Leverone
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Centro de Estudos das Unhas (CEU), Santa Casa de Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia Costa
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
| | - Bruna Duque Estrada
- Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Evidence-Based, Health of the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Priscilla Haui
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
| | - Flavio Luz
- Department of Dermatology, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
| | - Andre Fukunishi Yamada
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Hospital Do Coração, HCOR, São Paulo, Brazil
| | - Heron Werner
- Diagnósticos da América S/A, DASA, Avenida das Américas 4666, Sala 325, Rio de Janeiro, RJ, 22640-100, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Clarissa Canella
- DASA, Clínica Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
- Bio Design Laboratory, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
- Department of Radiology of Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
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7
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Wei X, Huo J, Yang Q, Li J. Early diagnosis of necrotizing fasciitis: Imaging techniques and their combined application. Int Wound J 2024; 21:e14379. [PMID: 37679292 PMCID: PMC10784425 DOI: 10.1111/iwj.14379] [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] [Received: 07/23/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Necrotizing fasciitis is a clinical, surgical emergency characterized by an insidious onset, rapid progression, and a high mortality rate. The disease's mortality rate has remained high for many years, mainly because of its atypical clinical presentation, which prevents many cases from being diagnosed early and accurately, resulting in patients who may die from uncontrollable septic shock and multi-organ failure. But unfortunately, no diagnostic indicator can provide a certain early diagnosis of NF, and clinical judgement of NF is still based on the results of various ancillary tests combined with the patient's medical history, clinical manifestations, and the physician's experience. This review provides a brief overview of the epidemiological features of NF and then discusses the most important laboratory indicators and scoring systems currently employed to diagnose NF. Finally, the latest progress of several imaging techniques in the early diagnosis of NF and their combined application with other diagnostic indices are highlighted. We point out promising research directions based on an objective evaluation of the advantages and shortcomings of different methods, which provide a basis for further improving the early diagnosis of NF.
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Affiliation(s)
- Xin‐ke Wei
- Department of Burns and Plastic SurgerySecond Affiliated Hospital of Air Force Military Medical UniversityXi'anChina
| | - Jun‐yi Huo
- Department of Burns and Plastic SurgerySecond Affiliated Hospital of Air Force Military Medical UniversityXi'anChina
| | - Qin Yang
- Department of Burns and Plastic SurgerySecond Affiliated Hospital of Air Force Military Medical UniversityXi'anChina
| | - Jing Li
- Department of Burns and Plastic SurgerySecond Affiliated Hospital of Air Force Military Medical UniversityXi'anChina
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8
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Kompel A, Guermazi A. Imaging of MSK infections in the ER. Skeletal Radiol 2023:10.1007/s00256-023-04554-7. [PMID: 38147081 DOI: 10.1007/s00256-023-04554-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Musculoskeletal infections in the ER are not an uncommon presentation. The clinical context is critical in determining the suspicion for infection and degree of tissue involvement which can involve all layers from the skin to bones. The location, extent, and severity of clinically suspected infection directly relate to the type of imaging performed. Uncomplicated cellulitis typically does not require any imaging. Localized and superficial infections can mostly be evaluated with ultrasound. If there is a diffuse site (an entire extremity) or suspected deeper involvement (muscle/deep fascia), then CT is accurate in diagnosing, widely available, and performed quickly. With potential osseous involvement, MRI is the gold standard for diagnosing acute osteomyelitis; however, it has the drawbacks of longer scan times, artifacts including patient motion, and limited availability.
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Affiliation(s)
- Andrew Kompel
- Boston University School of Medicine, Boston, MA, USA.
| | - Ali Guermazi
- Boston University School of Medicine, Boston, MA, USA
- Boston VA Healthcare System, West Roxbury, MA, USA
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9
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Ezemma O, Korman AM, Wang HE, Kaffenberger B. Diagnostic methods for the confirmation of non-purulent cellulitis: a review. Arch Dermatol Res 2023; 315:2519-2527. [PMID: 37421422 DOI: 10.1007/s00403-023-02658-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/11/2023] [Accepted: 06/18/2023] [Indexed: 07/10/2023]
Abstract
Cellulitis is the most common cause for skin disease hospitalization with costs totaling over $7 billion. It can be challenging to diagnose due to clinical similarities with other inflammatory conditions and the lack of a gold-standard diagnostic test. This article reviews the different testing methods for the diagnosis of non-purulent cellulitis based on three categories (1) clinical scoring assessments, (2) in vivo imaging techniques, and (3) laboratory assessments.
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Affiliation(s)
- Ogechi Ezemma
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Abraham M Korman
- Division of Dermatology, Department of Dermatology, The Ohio State University Wexner Medical Center, 2012 Kenny Road, 2nd Floor, Columbus, OH, 43212, USA
| | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin Kaffenberger
- Division of Dermatology, Department of Dermatology, The Ohio State University Wexner Medical Center, 2012 Kenny Road, 2nd Floor, Columbus, OH, 43212, USA.
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10
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Jardon M, Alaia EF. Approach to imaging modalities in the setting of suspected infection. Skeletal Radiol 2023:10.1007/s00256-023-04478-2. [PMID: 37857751 DOI: 10.1007/s00256-023-04478-2] [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: 08/01/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Imaging plays an important role in the workup of musculoskeletal infection, in conjunction with clinical history and physical exam. There are multiple imaging modalities that can be of clinical utility in the setting of suspected infection, each with their own benefits and limitations. Radiography is a low-cost, accessible modality providing a broad osseous overview, but can be insensitive for early osteomyelitis. Ultrasound plays a more limited role in the workup of musculoskeletal infection, but can be useful in the pediatric population or for real-time guidance for joint and soft tissue aspirations. Computed tomography (CT) plays an important role in the timely and accurate diagnosis of critically ill patients in the emergency setting. Its superior soft tissue characterization allows for diagnosis of abscesses, and it can help confirm the clinical diagnosis of necrotizing fasciitis when soft tissue gas is present. Magnetic resonance imaging (MRI) is often the modality of choice in the diagnosis of infection, as its superior contrast resolution allows for clear delineation of the presence and extent of both soft tissue infection and osteomyelitis. Additionally, the use of intravenous contrast and advanced imaging sequences such as diffusion weighted imaging (DWI) further increases the diagnostic utility of MRI in the assessment for infection. Familiarity with the diagnostic utility of each imaging modality will allow the radiologist to appropriately guide imaging workup in the setting of clinically suspected infection.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA.
| | - Erin F Alaia
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA
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11
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Weaver JS, Omar I, Epstein K, Brown A, Chadwick N, Taljanovic MS. High-resolution ultrasound in the evaluation of musculoskeletal infections. J Ultrason 2023; 23:e272-e284. [PMID: 38020512 PMCID: PMC10668941 DOI: 10.15557/jou.2023.0034] [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: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of Texas Health San Antonio, San Antonio, USA
| | - Imran Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Katherine Epstein
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | | | - Nicholson Chadwick
- Department of Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
- Departments of Medical Imaging and Orthopedic Surgery, Banner University Medical Center, Tucson, Arizona, USA
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12
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Ton C, Salehi S, Abasi S, Aggas JR, Liu R, Brandacher G, Guiseppi-Elie A, Grayson WL. Methods of ex vivo analysis of tissue status in vascularized composite allografts. J Transl Med 2023; 21:609. [PMID: 37684651 PMCID: PMC10492401 DOI: 10.1186/s12967-023-04379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
Vascularized composite allotransplantation can improve quality of life and restore functionality. However, the complex tissue composition of vascularized composite allografts (VCAs) presents unique clinical challenges that increase the likelihood of transplant rejection. Under prolonged static cold storage, highly damage-susceptible tissues such as muscle and nerve undergo irreversible degradation that may render allografts non-functional. Skin-containing VCA elicits an immunogenic response that increases the risk of recipient allograft rejection. The development of quantitative metrics to evaluate VCAs prior to and following transplantation are key to mitigating allograft rejection. Correspondingly, a broad range of bioanalytical methods have emerged to assess the progression of VCA rejection and characterize transplantation outcomes. To consolidate the current range of relevant technologies and expand on potential for development, methods to evaluate ex vivo VCA status are herein reviewed and comparatively assessed. The use of implantable physiological status monitoring biochips, non-invasive bioimpedance monitoring to assess edema, and deep learning algorithms to fuse disparate inputs to stratify VCAs are identified.
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Affiliation(s)
- Carolyn Ton
- Department of Biomedical Engineering, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
| | - Sara Salehi
- Department of Biomedical Engineering, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
| | - Sara Abasi
- Department of Biomedical Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA
- Department of Electrical and Computer Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA
- Media and Metabolism, Wildtype, Inc., 2325 3rd St., San Francisco, CA, 94107, USA
| | - John R Aggas
- Department of Biomedical Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA
- Department of Electrical and Computer Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA
- Test Development, Roche Diagnostics, 9115 Hague Road, Indianapolis, IN, 46256, USA
| | - Renee Liu
- Department of Biomedical Engineering, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
- Translational Tissue Engineering Center, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Reconstructive Transplantation Program, Center for Advanced Physiologic Modeling (CAPM), Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
| | - Anthony Guiseppi-Elie
- Department of Biomedical Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA.
- Department of Electrical and Computer Engineering, Center for Bioelectronics, Biosensors and Biochips (C3B®), Texas A&M University, Emerging Technologies Building 3120, 101 Bizzell St, College Station, TX, 77843, USA.
- Department of Cardiovascular Sciences, Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, USA.
- ABTECH Scientific, Inc., Biotechnology Research Park, 800 East Leigh Street, Richmond, VA, USA.
| | - Warren L Grayson
- Department of Biomedical Engineering, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA.
- Translational Tissue Engineering Center, Johns Hopkins University, 400 North Broadway, Smith Building 5023, Baltimore, MD, 21231, USA.
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, USA.
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13
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Pontes ÍCDM, Souza AR, Fonseca EKUN, Osawa A, Baroni RH, Castro ADAE. Musculoskeletal pitfalls in 68Ga-PSMA PET/CT. Radiol Bras 2023; 56:220-225. [PMID: 37829586 PMCID: PMC10567088 DOI: 10.1590/0100-3984.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 10/14/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) is a transmembrane protein expressed in normal prostate cells and overexpressed in prostate cancer. Consequently, it is an important tool in the evaluation of prostate cancer, including the staging of high-risk patients and the assessment of biochemical recurrence. Despite the "specific" designation, benign musculoskeletal conditions, such as fractures, osteodegenerative changes, and fibrous dysplasia, can also show PSMA uptake, which can lead to misinterpretation of the imaging findings. Therefore, radiologists must be aware of these potential pitfalls, understand their causes, and fully analyze their morphologic features on unfused computed tomography (CT) and magnetic resonance imaging scans to correctly interpret the examination. In this pictorial essay, we review the basic characteristics of the 68Ga-PSMA positron-emission tomography/CT (PET/CT) radiotracer, discuss potential causes of false-positive findings on 68Ga-PSMA PET/CT in the musculoskeletal system, and illustrate the corresponding imaging findings.
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Affiliation(s)
| | - Anthony Reis Souza
- Imaging Department, Hospital Israelita Albert Einstein, São
Paulo, SP, Brazil
| | | | - Akemi Osawa
- Imaging Department, Hospital Israelita Albert Einstein, São
Paulo, SP, Brazil
| | - Ronaldo Hueb Baroni
- Imaging Department, Hospital Israelita Albert Einstein, São
Paulo, SP, Brazil
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14
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Arkoudis NA, Moschovaki-Zeiger O, Prountzos S, Spiliopoulos S, Kelekis N. Caesarean-section scar endometriosis (CSSE): clinical and imaging fundamentals of an underestimated entity. Clin Radiol 2023:S0009-9260(23)00232-5. [PMID: 37380575 DOI: 10.1016/j.crad.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
Caesarean-section scar endometriosis (CSSE) is a form of extra-pelvic endometriosis developing through endometrial cell implantation anywhere along the route of a previous caesarean section (CS) surgery, including the skin, subcutaneous tissue, abdominal wall muscles, intraperitoneally, and the uterine scar itself. Synchronous intra-abdominal endometriosis is not a prerequisite. Given the rising prevalence of CS, CSSE may be underrepresented in the literature and occur more frequently than previously thought. Locating a painful soft-tissue mass-like lesion along the path of a previous CS scar is the most indicative sign that should initially alarm physicians towards suggesting CSSE, especially if symptoms are typical (cyclically reoccurring with menstruation). The detection of hyperintense (haemorrhagic) foci on T1 fat-saturated sequences will strongly support the diagnosis on magnetic resonance imaging (MRI), the most sensitive imaging method for CSSE assessment. A non-specific, contrast-enhancing, hypodense nodule with spiculate edges may be suggestive if the lesion was originally detected on computed tomography (CT). Although ultrasound is frequently the first imaging method used, the findings are non-specific; therefore, making it more useful for ruling out other differentials and for image-guided biopsy. In any case, histopathology provides the definitive diagnosis. Surgical excision is the mainstay of treatment; however, minimally invasive, percutaneous techniques have also been implemented successfully.
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Affiliation(s)
- N-A Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, Athens, 124 62, Greece.
| | - O Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, Athens, 124 62, Greece
| | - S Prountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, Athens, 124 62, Greece
| | - S Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, Athens, 124 62, Greece
| | - N Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, Athens, 124 62, Greece
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15
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Garcia-Diez AI, Tomas Batlle X, Perissinotti A, Isern-Kebschull J, Del Amo M, Soler JC, Bartolome A, Bencardino JT. Imaging of the Diabetic Foot. Semin Musculoskelet Radiol 2023; 27:314-326. [PMID: 37230131 DOI: 10.1055/s-0043-1764386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetic foot complications are increasingly prevalent in the world, leading to significant morbidity and driving up associated health care costs. Complex pathophysiology and suboptimal specificity of current imaging modalities have made diagnosis challenging, mainly in the evaluation of superimposed foot infection to underlying arthropathy or other marrow lesions. Recent advances in radiology and nuclear medicine have the potential to streamline the assessment of diabetic foot complications. But we must be aware of the specific strengths and weaknesses of each modality, and their applications. This review offers a comprehensive approach to the spectrum of diabetic foot complications and their imaging appearances in conventional and advanced imaging studies, including optimal technical considerations for each technique. Advanced magnetic resonance imaging (MRI) techniques are highlighted, illustrating their complementary role to conventional MRI, in particular their potential impact in avoiding additional studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Jenny Teresa Bencardino
- Division of Musculoskeletal Radiology, Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Sebastian A, Sebastian N, Arulthasan M, Simon R, Nicastro JM. Necrotizing Soft Tissue Infection Secondary to Streptococcus constellatus, Actinomyces odontolyticus, and Gemella morbillorum in an Intravenous Drug User: A Case Report and Literature Review. Cureus 2023; 15:e37314. [PMID: 37181983 PMCID: PMC10167094 DOI: 10.7759/cureus.37314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
A 53-year-old male with active IV heroin use presented with left upper extremity pain, erythema, swelling, and purulent foul-smelling drainage. Rapid diagnosis of necrotizing soft tissue infection (NSTI) was made based on clinical and radiologic findings. He was taken to the operating room for wound washouts and surgical debridements. The early microbiologic diagnosis was made based on intraoperative cultures. Successful treatment of NSTI in the setting of rare pathogens was achieved. The wound was ultimately treated with wound vac therapy, followed by primary delayed closure of the upper extremity and skin grafting of the forearm. We present a case of NSTI secondary to Streptococcus constellatus, Actinomyces odontolyticus, and Gemella morbillorum in an intravenous (IV) drug user, successfully treated with early surgical intervention.
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Affiliation(s)
| | | | | | - Ronald Simon
- Surgery, Maimonides Medical Center, Brooklyn, USA
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17
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Lee AH, Berlyand Y, Dutta S, Succi MD, Sonis JD, Yun BJ, Raja AS, Prabhakar A, Baugh JJ. CT utilization in evaluation of skin and soft tissue extremity infections in the ED: Retrospective cohort study. Am J Emerg Med 2023; 64:96-100. [PMID: 36502653 DOI: 10.1016/j.ajem.2022.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Skin and soft tissue infections (SSTI) are commonly diagnosed in the emergency department (ED). While most SSTI are diagnosed with patient history and physical exam alone, ED clinicians may order CT imaging when they suspect more serious or complicated infections. Patients who inject drugs are thought to be at higher risk for complications from SSTI and may undergo CT imaging more frequently. The objective of this study is to characterize CT utilization when evaluating for SSTI in ED patients particularly in patients with intravenous drug use (IVDU), the frequency of significant and actionable findings from CT imaging, and its impact on subsequent management and ED operations. METHODS We performed a retrospective analysis of encounters involving a diagnosis of SSTI in seven EDs across an integrated health system between October 2019 and October 2021. Descriptive statistics were used to assess overall trends, compare CT utilization frequencies, actionable imaging findings, and surgical intervention between patients who inject drugs and those who do not. Multivariable logistic regression was used to analyze patient factors associated with higher likelihood of CT imaging. RESULTS There were 4833 ED encounters with an ICD-10 diagnosis of SSTI during the study period, of which 6% involved a documented history of IVDU and 30% resulted in admission. 7% (315/4833) of patients received CT imaging, and 22% (70/315) of CTs demonstrated evidence of possible deep space or necrotizing infections. Patients with history of IVDU were more likely than patients without IVDU to receive a CT scan (18% vs 6%), have a CT scan with findings suspicious for deep-space or necrotizing infection (4% vs 1%), and undergo surgical drainage in the operating room within 48 h of arrival (5% vs 2%). Male sex, abnormal vital signs, and history of IVDU were each associated with higher likelihood of CT utilization. Encounters involving CT scans had longer median times to ED disposition than those without CT scans, regardless of whether these encounters resulted in admission (9.0 vs 5.5 h), ED observation (5.5 vs 4.1 h), or discharge (6.8 vs 2.9 h). DISCUSSION ED clinicians ordered CT scans in 7% of encounters when evaluating for SSTI, most frequently in patients with abnormal vital signs or a history of IV drug use. Patients with a history of IVDU had higher rates of CT findings suspicious for deep space infections or necrotizing infections and higher rates of incision and drainage procedures in the OR. While CT scans significantly extended time spent in the ED for patients, this appeared justified by the high rate of actionable findings found on imaging, particularly for patients with a history of IVDU.
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Affiliation(s)
- Andy H Lee
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA.
| | - Yosef Berlyand
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Marc D Succi
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA
| | - Jonathan D Sonis
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Brian J Yun
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, Boston Medical Center, 725 Albany Street, Boston, MA, USA
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA
| | - Anand Prabhakar
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA
| | - Joshua J Baugh
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
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18
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Porrino J, Liu X, Kani K, Lee H. Spectrum of imaging findings in soft-tissue necrosis. Emerg Radiol 2023; 30:217-223. [PMID: 36626029 DOI: 10.1007/s10140-023-02113-0] [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] [Received: 11/12/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Soft tissue necrosis can occur at different tissue levels, with numerous underlying causes. In this pictorial review, we highlight myonecrosis, and its accompanying stages, fat necrosis, devitalized soft tissue seen with infection, and necrotizing soft tissue infections. Imaging examples are provided with each entity.
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Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA.
| | - Xiaozhou Liu
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Kimia Kani
- Department of Radiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Hyojeong Lee
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA
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19
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Salastekar N, Su A, Rowe JS, Somasundaram A, Wong PK, Hanna TN. Imaging of Soft Tissue Infections. Radiol Clin North Am 2023; 61:151-166. [DOI: 10.1016/j.rcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Malik DG, Dahiya N, Young SW, Heng LXX, Patel MD. Non-Vascular Considerations When Interpreting Extremity Arterial and Venous Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3145-3158. [PMID: 35984099 DOI: 10.1002/jum.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Peripheral arterial and venous examinations are performed regularly in vascular labs and interpreted by physicians of different specialities. Many vascular examinations have nonvascular pathology that is either inadvertently imaged by the sonographer or imaged with intent as it relates to patient's symptoms. It is prudent for every reader of vascular studies to be acquainted with the sonographic appearance of these non-vascular lesions to enable appropriate and optimal interpretation that has a direct bearing on patient's clinical care. Our review includes a discussion of the nonvascular pathologies like lymph nodes, soft tissue edema, soft tissue fluid collections, musculotendinous injuries, soft tissue masses, and joint and bursal pathologies that may be encountered during interpretation of vascular exams. The pictorial essay includes a discussion of their sonographic appearances and pitfalls in interpretation. Multiple illustrative examples and sonographic images of the non-vascular pathologies found during interpretation of vascular studies have been utilized to highlight their appearances.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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21
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Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review. Microorganisms 2022; 10:microorganisms10122329. [PMID: 36557582 PMCID: PMC9784663 DOI: 10.3390/microorganisms10122329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. MRI is considered the most comprehensive and sensitive imaging tool available for the assessment of musculoskeletal infections. Ultrasound is a fundamental tool, especially for the evaluation of superficially located diseases and for US-guided interventional procedures, such as biopsy, needle-aspiration, and drainage. Conventional radiographs can be very helpful, especially for the detection of foreign bodies and in cases of infections with delayed diagnosis displaying bone involvement. This review article aims to provide a comprehensive overview of the radiological tools available and the imaging features of the most common musculoskeletal soft-tissue infections, including cellulitis, necrotizing and non-necrotizing fasciitis, foreign bodies, abscess, pyomyositis, infectious tenosynovitis, and bursitis.
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22
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Pierce JL, Perry MT, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Caracciolo JT, DeGeorge KC, Demertzis JL, Garner HW, Scott JA, Sharma A, Beaman FD. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022; 19:S473-S487. [PMID: 36436971 DOI: 10.1016/j.jacr.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Musculoskeletal infections involve bones, joints, and soft tissues. These infections are a common clinical scenario in both outpatient and emergent settings. Although radiography provides baseline findings, a multimodality approach is often implemented to provide more detailed information on the extent of infection involvement and complications. MRI with intravenous contrast is excellent for the evaluation of musculoskeletal infections and is the most sensitive for diagnosing osteomyelitis. MRI, CT, and ultrasound can be useful for joint and soft tissue infections. When MRI or CT is contraindicated, bone scans and the appropriate utilization of other nuclear medicine scans can be implemented for aiding in the diagnostic imaging of infection, especially with metal hardware and arthroplasty artifacts on MRI and CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Jennifer L Pierce
- University of Virginia, Charlottesville, Virginia; Associate Division Chair, Musculoskeletal Radiology, University of Virginia; Radiology Residency Global Health Leadership Track Program Director, University of Virginia.
| | - Michael T Perry
- Research Author, University of Virginia Health Center, Charlottesville, Virginia
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- The Johns Hopkins University School of Medicine, Baltimore, Maryland; member
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; MSK Imaging and Interventions Fellowship Director, Mallinckrodt Institute of Radiology
| | - James Banks
- Aventura Hospital, Aventura, Florida; Student Radiology Rotation Clerkship Director for HCA Florida Aventura and Kendall Hospitals; Nova Southeastern University, Fort Lauderdale, Florida
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee; Section Head, MSK Imaging, Moffitt Cancer Center; Chairman, ACR MSK-RADS Committee
| | - Katharine C DeGeorge
- University of Virginia, Charlottesville, Virginia; Primary care physician; Deputy Editor, DynaMed; and Advisory Board, Flo Health Medical
| | - Jennifer L Demertzis
- Diagnostic Imaging Associates, Chesterfield, Missouri; Partner, ProSight Radiology
| | - Hillary W Garner
- Mayo Clinic Florida, Jacksonville, Florida; Committee Chair, Society of Skeletal Radiology and International Skeletal Society
| | - Jinel A Scott
- SUNY Downstate Health Sciences University, Brooklyn, New York; Chief Quality Officer
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging; Chair, Research Committee, Radiology, Mayo Clinic Florida; PET-MRI workgroup, Mayo Clinic Florida
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Unexpected finding of Fournier’s gangrene diagnosed by 18F-FDG PET/CT in a patient with metastatic lung adenocarcinoma. Rev Esp Med Nucl Imagen Mol 2022:S2253-8089(22)00110-0. [PMID: 36423794 DOI: 10.1016/j.remnie.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
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24
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman DF, Jacobson JA, Narouze S, Nazarian LN, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2395-2412. [PMID: 35103998 DOI: 10.1002/jum.15947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Sandra Allison
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joseph Craig
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph P DeAngelis
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Atul Gupta
- Department of Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Department of Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah W Ray
- Departments of Emergency Medicine and Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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25
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Moreno-Ballesteros A, González-Cámpora R, Navarro-Vázquez S, Arce-Durán J, González-Gaggero B. Hallazgo inesperado de gangrena de Fournier en la PET/TC con 18FDG de un paciente con adenocarcinoma de pulmón metastásico. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Mandell JC, Khurana B. Musculoskeletal Trauma and Infection. Magn Reson Imaging Clin N Am 2022; 30:441-454. [PMID: 35995472 DOI: 10.1016/j.mric.2022.04.007] [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: 10/15/2022]
Abstract
MR is often the most definitive imaging for assessment of musculoskeletal trauma and infection. Although it is not possible to address all the intricacies of these complex topics in a single article, this review will attempt to provide a useful toolbox of skills by discussing several common clinical scenarios faced by emergency radiologists in interpretation of adult trauma and infection. These scenarios include MR assessment of hip and pelvic fracture, traumatic soft tissue injuries, septic arthritis, soft tissue infection, and osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Musculoskeletal Imaging and Intervention, Division of Musculoskeletal Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Brigham and Women's Hospital, Trauma Imaging Research and Innovation Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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27
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Lensink K, Lo F(J, Eddy RL, Law M, Laradji I, Haber E, Nicolaou S, Murphy D, Parker WA. A Soft Labeling Approach to Develop Automated Algorithms that Incorporate Uncertainty in Pulmonary Opacification on Chest CT using COVID-19 Pneumonia. Acad Radiol 2022; 29:994-1003. [PMID: 35490114 DOI: 10.1016/j.acra.2022.03.025] [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: 01/23/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Hard data labels for automated algorithm training are binary and cannot incorporate uncertainty between labels. We proposed and evaluated a soft labeling methodology to quantify opacification and percent well-aerated lung (%WAL) on chest CT, that considers uncertainty in segmenting pulmonary opacifications and reduces labeling burden. MATERIALS AND METHODS We retrospectively sourced 760 COVID-19 chest CT scans from five international centers between January and June 2020. We created pixel-wise labels for >27,000 axial slices that classify three pulmonary opacification patterns: pure ground-glass, crazy-paving, consolidation. We also quantified %WAL as the total area of lung without opacifications. Inter-user hard label variability was quantified using Shannon entropy (range=0-1.39, low-high entropy/variability). We incorporated a soft labeling and modeling cycle following an initial model with hard labels and compared performance using point-wise accuracy and intersection-over-union of opacity labels with ground-truth, and correlation with ground-truth %WAL. RESULTS Hard labels annotated by 12 radiologists demonstrated large inter-user variability (3.37% of pixels achieved complete agreement). Our soft labeling approach increased point-wise accuracy from 60.0% to 84.3% (p=0.01) compared to hard labeling at predicting opacification type and area involvement. The soft label model accurately predicted %WAL (R=0.900) compared to the hard label model (R=0.856), but the improvement was not statistically significant (p=0.349). CONCLUSION Our soft labeling approach increased accuracy for automated quantification and classification of pulmonary opacification on chest CT. Although we developed the model on COVID-19, our intent is broad application for pulmonary opacification contexts and to provide a foundation for future development using soft labeling methods.
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Vicentini JR, Chang CY. MR Imaging of the Knee Bursae and Bursal Pathology. Magn Reson Imaging Clin N Am 2022; 30:241-260. [DOI: 10.1016/j.mric.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shim H, Varakin N, Meyr AJ. Anatomic and Treatment Descriptive Features of Foot Infections Presenting With Radiographic Soft Tissue Emphysema. J Foot Ankle Surg 2022; 61:323-326. [PMID: 34607779 DOI: 10.1053/j.jfas.2021.08.012] [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: 06/22/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 02/03/2023]
Abstract
Foot infections associated with soft tissue emphysema, or the radiographic appearance of gas, are widely considered to necessitate urgent decompression with excisional debridement of the necrotic and infectious tissue burden. The objective of this investigation was to describe anatomic features and clinical outcomes associated with the presence of soft tissue emphysema in foot infections. A retrospective chart review was performed of 62 subjects meeting selection criteria. These were primarily male (74.2%), with a history of diabetes mellitus (85.5%), and without a history of previous lower extremity revascularization (98.4%). The primary radiographic location of the soft tissue emphysema was most frequently in the forefoot (61.3%), followed by the midfoot (21.0%), and rearfoot (16.1%). The soft tissue emphysema was most frequently observed primarily in the dorsal foot tissue (49.2%), followed by both dorsal and plantar foot tissue (27.4%), and the plantar foot tissue (24.2%). The soft tissue emphysema was confined to the primary anatomic location in 74.2% of subjects, while 25.8% of cases demonstrated extension into a more proximal anatomic area. Eighty-two percent of subjects underwent a bedside incision and drainage procedure on presentation in the emergency department, and 95.2% underwent a formal incision and drainage procedure in the operating room at 1.05 ± 0.79 (0-5) postadmission days. Twenty-seven percent of subjects had an unplanned 30-day readmission and 17.7% underwent an unplanned reoperation within 30 days following the index discharge. Fifty-two percent of subjects underwent a minor or major amputation during the index admission, while 33.9% eventually resulted in major limb amputation within 12 months. We hope that this investigation adds to the body of knowledge and provides expectations with respect to the evaluation and treatment of foot soft tissue infections complicated by the presence of radiographic soft tissue emphysema.
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Affiliation(s)
- Hyun Shim
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Nicholas Varakin
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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30
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Boettler MA, Kaffenberger BH, Chung CG. Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis. Am J Clin Dermatol 2022; 23:153-165. [PMID: 34902109 DOI: 10.1007/s40257-021-00659-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
Cellulitis, an infection involving the deep dermis and subcutaneous tissue, is the most common reason for skin-related hospitalization and is seen by clinicians across various disciplines in the inpatient, outpatient, and emergency room settings, but it can present as a diagnostic and therapeutic challenge. Cellulitis is a clinical diagnosis based on the history of present illness and physical examination and lacks a gold standard for diagnosis. Clinical presentation with acute onset of redness, warmth, swelling, and tenderness and pain is typical. However, cellulitis can be difficult to diagnose due to a number of infectious and non-infectious clinical mimickers such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans. Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens. The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient. Even with rising rates of community-acquired methicillin-resistant Staphylococcus aureus, coverage for non-purulent cellulitis is generally not recommended.
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Imaging of innate immunity activation in vivo with a redox-tuned PET reporter. Nat Biotechnol 2022; 40:965-973. [DOI: 10.1038/s41587-021-01169-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/19/2021] [Indexed: 12/26/2022]
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Shareef M, Ghosn Y, Khdhir M, El Annan T, Alam R, Hourani R. Critical infections in the head and neck: A pictorial review of acute presentations and complications. Neuroradiol J 2022:19714009211059122. [PMID: 35188822 DOI: 10.1177/19714009211059122] [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: 11/15/2022] Open
Abstract
Non-traumatic head and neck emergencies include several disease processes such as infectious, inflammatory, and malignant. Infections are among the most common pathological processes that affect the head and neck, and are particularly important due to their acute, severe, and potentially life-threatening nature. Radiologists need to be well acquainted with these entities because any delay or misdiagnosis can lead to significant morbidity and mortality. Having a general understanding of such diseases is crucial, their prevalence, clinical presentation, common causative pathogens, route of spread, potential complications, and multimodality radiological appearance. Furthermore, understanding the relevant anatomy of the region, including the various fascial planes and spaces, is essential for radiologists for accurate image interpretation and assessment of potential complications. Our aim is to review the most common severe infections affecting the head and neck as well as other rare but potentially life-threatening infections. We will also describe their imaging features while focusing on the anatomy of the regions involved and describing their potential complications and treatment options.
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Affiliation(s)
| | - Youssef Ghosn
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Mihran Khdhir
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Tamara El Annan
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Raquelle Alam
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, 66984American University of Beirut, Lebanon
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Abstract
Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.
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Affiliation(s)
- Bryan P. Kline
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Nimalan A. Jeganathan
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania,Address for correspondence Nimalan A. Jeganathan, MD Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine500 University Drive, Hershey, PA 17033-0850
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman D, Jacobson JA, Narouze S, Nazarian L, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended musculoskeletal and sports ultrasound terminology: a Delphi-based consensus statement. Br J Sports Med 2022; 56:310-319. [PMID: 35110328 DOI: 10.1136/bjsports-2021-105114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/26/2022]
Abstract
The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Orthopedics and Rehabilitation, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | - Joseph Craig
- Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | | - Jonathan T Finnoff
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA.,Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Orthopedic Surgery, University of Colorado, Denver, Colorado, USA
| | - Atul Gupta
- Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas Hoffman
- Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon Nazarian
- Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah Wayne Ray
- Emergency Medicine, University of California Davis, Davis, California, USA
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Jay Smith
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Institute of Advanced Ultrasound Guided Procedures, Sonex Health, Inc, Eagan, Minnesota, USA
| | - Alberto Tagliafico
- Health Sciences, University of Genoa, Genova, Italy.,Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Noriega-Álvarez E, Pena Pardo FJ, Jiménez Londoño GA, García Vicente A. Gamma camera imaging of musculoskeletal infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00215-5] [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] Open
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Lymphangitis Carcinomatosa in Neck Soft Tissue. J Comput Assist Tomogr 2021; 46:140-144. [DOI: 10.1097/rct.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iwakawa H, Uchiyama S, Fujinaga Y, Hayashi M, Komatsu M, Kato H, Takahashi J. Magnetic resonance imaging of diffusion characteristics following collagenase clostridium histolyticum injection in Dupuytren's contracture. J Orthop Surg (Hong Kong) 2021; 29:23094990211047281. [PMID: 34654338 DOI: 10.1177/23094990211047281] [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] [Indexed: 11/15/2022] Open
Abstract
PurposeWe aimed to evaluate the extent of collagenase clostridium histolyticum (CCH) diffusion in Dupuytren's contracture (DC) for tissues outside of the contracture cord using Magnetic Resonance Imaging (MRI) immediately after CCH injection. Methods: 10 male patients aged 57-79 with DC of the metacarpophalangeal (MCP) joints were examined. Extension deficits were 10-60°(mean, 34.3) and 0-60°(mean, 26.6) in the MCP and proximal interphalangeal (PIP) joints, respectively. CCH injection was performed according to the standard method. MRI was performed within 15 min of CCH injection. Results: In all 10 cases, the extended area of high-intensity signal change outside of the cord was observed on short-T1 inversion recovery images (STIRs). Continuity from the insertion site was observed in the area of signal change involving the flexor tendon and neurovascular bundle. The signal change area spanned distally and proximally beyond the injection level. The signal change area expanded along the tendon sheath but no signal changes were observed inside the flexor tendon, suggesting the tendon sheath serves as a protective barrier from the CCH solution. After 1 week of injection, the mean decrease in contracture was 32.5°(94.7%) for the MCP joint and 19.8°(74.4%) for the PIP joint. In nine out of 10 cases, the extension deficit was within five degrees of full extension in the affected finger. There was no neurovascular injury or tendon rupture at 3 months of observation. Conclusions: MRI indicated the possible leakage of the drug outside of the cord during the early phase after administration, suggesting that CCH could persistently affect healthy tissues until CCH inactivates its enzyme process.
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Affiliation(s)
- Hiroko Iwakawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masatoshi Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Thippeswamy PB, Nedunchelian M, Rajasekaran RB, Riley D, Khatkar H, Rajasekaran S. Updates in postoperative imaging modalities following musculoskeletal surgery. J Clin Orthop Trauma 2021; 22:101616. [PMID: 34660193 PMCID: PMC8502706 DOI: 10.1016/j.jcot.2021.101616] [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: 09/21/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Postoperative imaging following orthopaedic surgeries is essential in assessing complications post-surgery and also helps plan further treatment. Combining a high degree of clinical insight with appropriate imaging can guide the treating clinician to the correct diagnosis. Imaging is quite challenging because of surgery-related soft tissue changes, especially in the early postoperative period and the presence of metal implants resulting in image scatter and metal artifacts. Newer modalities and advances in imaging have helped overcome shortcomings and assess better, especially in procedures that involve implants. Collaborative decision-making involving radiologists and clinicians has shown to be beneficial and is the way forward. This narrative review discusses the utility of imaging in evaluating postoperative complications following musculoskeletal surgeries with specific relation to trauma, arthroplasty, and tumour by discussing commonly encountered clinical scenarios.
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Affiliation(s)
- Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Meena Nedunchelian
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Raja Bhaskara Rajasekaran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
- Corresponding author. 17, Horwood Close, Headington, Oxford, OX3 7RF, UK.
| | - Dylan Riley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Abstract
The clinical diagnosis of musculoskeletal infections can be challenging due to non-specific signs and symptoms on presentation. These infections include infectious myositis, necrotising fasciitis, septic arthritis, septic bursitis, suppurative tenosynovitis, osteomyelitis, spondylodiscitis and periprosthetic infections. Diagnostic imaging is routinely employed as part of the investigative pathway to characterise the underlying infectious disease pattern, allowing expedited and customised patient management plans to optimise outcomes. This article provides an update on the various imaging modalities comprising of radiography, computed tomography, ultrasonography, magnetic resonance imaging and radionuclide procedures, and incorporates representative images of key findings in the different forms of musculoskeletal infections.
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40
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Wang Y, Liang W. Infra-axillary proliferative myositis mimicking a malignant tumor on medical imaging: a case description. Quant Imaging Med Surg 2021; 11:4216-4218. [PMID: 34476201 DOI: 10.21037/qims-20-1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Yubizhuo Wang
- Department of Radiology, Yiwu Central Hospital, Yiwu, China
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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41
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Kawaguchi M, Kato H, Nagasawa T, Kaneko Y, Taguchi K, Ikeda T, Morita H, Miyazaki T, Matsuo M. MR imaging findings of musculoskeletal involvement in microscopic polyangiitis: a comparison with inflammatory myopathy. Radiol Med 2021; 126:1601-1608. [PMID: 34415508 DOI: 10.1007/s11547-021-01407-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the importance of MR imaging findings of musculoskeletal involvement of the lower limbs in diagnosing microscopic polyangiitis (MPA) vs polymyositis (PM) or dermatomyositis (DM). MATERIALS AND METHODS This study included 13 patients diagnosed with MPA clinically and through histologically, and 38 diagnosed with PM/DM, who underwent MR imaging of the lower limbs prior to treatment. Axial and coronal short tau inversion recovery (STIR) images were reviewed retrospectively. RESULTS The sites affected by MPA were the lower legs in six (46%) patients and the thighs in seven (54%). Intramuscular hyperintensity and fascial hyperintensity were observed in all cases of MPA (100%). Fascial hyperintensity was more frequently encountered in MPA than in PM/DM (100% vs. 45%, p < 0.01). As the predominantly involved sites, the fascial regions were more frequently affected by MPA than by PM/DM (77% vs. 18%, p < 0.01). Diffuse subcutaneous fat hyperintensity was more frequently observed in MPA than in PM/DM (100% vs. 16%, p < 0.01). However, no significant differences in intramuscular hyperintensity (100% vs. 97%, p = 0.745) and subcutaneous fat hyperintensity (54% vs. 50%, p = 0.533) were found between MPA and PM/DM. CONCLUSION Intramuscular hyperintensity and fascial hyperintensity have always been observed in MPA, and the predominantly affected sites were usually the fascial regions. Compared with PM/DM, fascial hyperintensity and diffuse subcutaneous fat hyperintensity were more frequent in MPA.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomoaki Nagasawa
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yo Kaneko
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koichiro Taguchi
- Department of General Internal Medicine, Gifu University, Gifu, Japan
| | - Takahide Ikeda
- Department of General Internal Medicine, Gifu University, Gifu, Japan
| | - Hiroyuki Morita
- Department of General Internal Medicine, Gifu University, Gifu, Japan
| | | | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Carneiro BC, Cruz IAN, Chemin RN, Rizzetto TA, Guimarães JB, Silva FD, Junior CY, Pastore D, Ormond Filho AG, Nico MAC. Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges. Radiographics 2021; 40:1965-1986. [PMID: 33136481 DOI: 10.1148/rg.2020200061] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic wounds and lacerations are a common reason for patients to present to emergency departments, with retained foreign bodies (FBs) accounting for 7%-15% of cases, particularly those involving the extremities. These retained materials result in a granulomatous tissue response known as an FB reaction, a pathologic attempt to isolate the FB from the host. The most common FB materials are glass, metal, and wood, but other compositions can also be found, such as plastic and animal-derived materials. Clinical history, physical examination, and wound exploration are essential in investigation of retained material but are not sufficient to exclude an FB, and additional investigation is required. Imaging evaluation is a useful tool to help depict and locate an FB, assess possible complications, and guide removal. Conventional radiography, the first-line method in this scenario, is a widely available low-cost depiction method that has good sensitivity for depicting FBs. If the retained material is not depicted at conventional radiography, US can be performed. US is highly sensitive in depicting both radiolucent and radiopaque FBs in superficial locations. For deeper objects, CT may be necessary. MRI is the best imaging modality to delineate local soft-tissue and osseous complications. Retained FBs can result in early and delayed complications, with infection being the most frequent complication. To avoid preventable morbidities related to FBs, radiologists should be familiar with imaging findings and provide essential information to help the attending physician treat each patient. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Bruno C Carneiro
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Isabela A N Cruz
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Renan N Chemin
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Thiago A Rizzetto
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Júlio B Guimarães
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Flávio D Silva
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Ciro Yoshida Junior
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Daniel Pastore
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Alípio G Ormond Filho
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
| | - Marcelo A C Nico
- From the Department of Musculoskeletal Radiology, Fleury Medicina e Saúde Higienópolis, Rua Mato Grosso 306, 1st Floor, Higienópolis, São Paulo, SP, Brazil 01239-040
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Richter RH, Byerly D, Schultz D, Mansfield LT. Challenges in the Interpretation of MRI Examinations Without Radiographic Correlation: Pearls and Pitfalls to Avoid. Cureus 2021; 13:e16419. [PMID: 34414045 PMCID: PMC8364739 DOI: 10.7759/cureus.16419] [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] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
As physics introduces more complex and seemingly thorough techniques to evaluate patient symptoms, cross-sectional imaging, especially magnetic resonance imaging (MRI), seems like the modality of choice to best help patients. However, musculoskeletal radiology (MSK) requires not just the excellent soft-tissue contrast provided by MRI but also an evaluation of the aggressiveness of a lesion, a detailed evaluation of osseous anatomy or distribution of disease, and a way to easily identify calcifications and gas in soft tissue in order to make the correct diagnosis. This article will demonstrate, through numerous cases, the importance of radiographs in the full characterization of MSK-related pathology. It will focus on imaging pearls and pitfalls to avoid when radiographs are not available and discuss the findings that can be expected if comparison radiographs were available.
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Affiliation(s)
- Ryan H Richter
- Department of Radiology, Brooke Army Medical Center, San Antonio, USA
| | - Douglas Byerly
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, USA
- Department of Radiology, Wilford Hall Ambulatory Surgical Center, San Antonio, USA
| | - Donald Schultz
- Department of Radiology, Brooke Army Medical Center, San Antonio, USA
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Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for Wound Infections. Adv Wound Care (New Rochelle) 2021; 10:317-327. [PMID: 32496977 DOI: 10.1089/wound.2019.1103] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significance: Infections can significantly delay the healing process in chronic wounds, placing an enormous economic burden on health care resources. Identification of infection biomarkers and imaging modalities to observe and quantify them has seen progress over the years. Recent Advances: Traditionally, clinicians determine the presence of infection through visual observation of wounds and confirm their diagnosis through wound culture. Many laboratory markers, including C-reactive protein, procalcitonin, presepsin, and bacterial protease activity, have been quantified to assist diagnosis of infection. Moreover, imaging modalities like plain radiography, computed tomography, magnetic resonance imaging, ultrasound imaging, spatial frequency domain imaging, thermography, autofluorescence imaging, and biosensors have emerged for real-time wound infection diagnosis and showed their unique advantages in deeper wound infection diagnosis. Critical Issues: While traditional diagnostic approaches provide valuable information, they are time-consuming and depend on clinicians' experiences. There is a need for noninvasive wound infection diagnostics that are highly specific, rapid, and accurate, and do not require extensive training. Future Directions: While innovative diagnostics utilizing various imaging instrumentation are being developed, new biomarkers have been investigated as potential indicators for wound infection. Products may be developed to either qualitatively or quantitatively measure these biomarkers. This review summarizes and compares all available diagnostics for wound infection, including those currently used in clinics and still under development. This review could serve as a valuable resource for clinicians treating wound infections as well as patients and wound care providers who would like to be informed of the recent developments.
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Affiliation(s)
- Shuxin Li
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
| | - Paul Renick
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
| | - Jon Senkowsky
- Texas Health Physician's Group, Arlington, Texas, USA
| | | | - Liping Tang
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
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Azzopardi C, Kiernan G, Botchu R. Imaging review of normal anatomy and pathological conditions involving the popliteus. J Clin Orthop Trauma 2021; 18:224-229. [PMID: 34123721 PMCID: PMC8173307 DOI: 10.1016/j.jcot.2021.05.029] [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: 01/12/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
Popliteus is an integral component of the posterolateral corner of the knee. We review the anatomy and various pathologies affecting the popliteus.
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Affiliation(s)
- Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Gareth Kiernan
- Department of Radiology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital Bristol Road South Northfield, Birmingham, UK.
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Furman MS, Restrepo R, Kritsaneepaiboon S, Laya BF, Plut D, Lee EY. Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians. Semin Musculoskelet Radiol 2021; 25:167-175. [PMID: 34020476 DOI: 10.1055/s-0041-1723004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.
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Affiliation(s)
- Michael S Furman
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island
| | - Ricardo Restrepo
- Interventional Pediatric Radiology and Body Imaging, Division of Radiology, Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - Supika Kritsaneepaiboon
- Section of Pediatric Imaging, Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Bernard F Laya
- Institute of Radiology, Section of Pediatric Radiology, St. Luke's Medical Center-Quezon City, St. Luke's Medical Center College of Medicine - William H. Quasha Memorial, Quezon City, Philippines
| | - Domen Plut
- Division of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre and Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
Myositis is inflammation especially of the voluntary muscles, characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The two main categories of myositis include non-infectious and infectious. Infective myositis may be due to a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. A brief account of the various pathogens causing infective myositis is discussed.
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Affiliation(s)
- Gayathri Narayanappa
- Department of NeuropathologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
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Johnson M, Sreela LS, Mathew P, Prasad TS. Actual applications of magnetic resonance imaging in dentomaxillofacial region. Oral Radiol 2021; 38:17-28. [PMID: 33635492 DOI: 10.1007/s11282-021-00521-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/13/2021] [Indexed: 11/24/2022]
Abstract
Magnetic resonance imaging (MRI) is a versatile imaging modality utilized in various medical fields. Specifically used for evaluation of soft tissues, with non-ionizing radiation and multiplanar sections that has provided great guidance to diagnosis. Nowadays, use of MRI in dental practice is becoming more pervasive, especially for the evaluation of head-and-neck cancer, detection of salivary gland lesions, lymphadenopathy, and temporomandibular joint disorders. Understanding the basic principles, its recent advances, and multiple applications in dentomaxillofacial region helps significantly in the diagnostic decision making. In this article, the principle of MRI and its recent advances are reviewed, with further discussion on the appearance of various maxillofacial pathosis.
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Affiliation(s)
- Migi Johnson
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India.
| | - L S Sreela
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
| | - Philips Mathew
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
| | - Twinkle S Prasad
- Department of Oral Medicine and Radiology, Government Dental College Kottayam, Gandhinagar, Kottayam, 686008, Kerala, India
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Torimitsu S, Abe H, Makino Y, Yamaguchi R, Motomura A, Hoshioka Y, Iwase H. Streptococcal toxic shock syndrome with fatal outcome: Report on four forensic autopsy cases. Leg Med (Tokyo) 2021; 50:101851. [PMID: 33578046 DOI: 10.1016/j.legalmed.2021.101851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022]
Abstract
Streptococcal toxic shock syndrome (STSS) is a severe infection most commonly caused by group A streptococcus. It is clinically characterized by rapidly progressive multiple organ failure and septic shock. This report presents four fatal cases associated with STSS. In two cases (cases 2 and 3), the portals of entry may be ulcer and mucosa at the surgical site; the initial symptoms in these cases included fever. In the other cases, the portal of entry was unknown; the initial symptom was pain. In two cases (cases 1 and 3), malpractice was suspected before autopsy. At autopsy, blood culture was positive for group A streptococcus in all of the present cases. Although C-reactive protein levels were increased, procalcitonin levels were not markedly elevated. This is the first report of autopsy cases associated with STSS in which postmortem computed tomography was performed; the swelling of muscles and increased concentrations of peripheral subcutaneous tissue without gas may be characteristic findings. Histology revealed extensive bacterial colonies and necrosis with mild neutrophilic reaction in two cases (cases 3 and 4), and hemophagocytosis in two cases (cases 1 and 4). It is essential to perform appropriate examinations and make a proper diagnosis because STSS still has a high fatality rate and medical malpractice is often suspected. In addition, it is important to evaluate STSS again for the reduction of the fatal cases associated with STSS.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Ayumi Motomura
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Yumi Hoshioka
- Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Necrotizing Soft-Tissue Infections: Clinical Features and Diagnostic Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33079362 DOI: 10.1007/978-3-030-57616-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2023]
Abstract
The term necrotizing soft-tissue infection (NSTI) encompasses a heterogenous group of patients with necrotizing infections, involving any body part. NSTI is diagnosed by surgical exploration, where necrosis of the subcutaneous tissue and/or muscle tissue, undermining of the skin, thrombosis of the superficial veins, and deliquescent tissue can be seen. Patients can present with vague symptoms, and approximately half of patients experience severe pain. The clinical presentation and microbiological etiology vary according to affected body site, with NSTI located to the extremities being dominated by monomicrobial group A streptococcal infections, and NSTI located to the anogenital area dominated by polymicrobial infections. No set of diagnostic criteria exists, and suspicion of the diagnosis should come from careful clinical examination and signs of local or systemic severity. Laboratory blood values show no distinct pattern but resemble those of sepsis. Imaging can aid the diagnostic process but must not delay surgical intervention.
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