1
|
Malhotra G, Hansford BG, Felcher C, Wuerfel KA, Yablon CM. Fluoroscopic-guided procedures of the lower extremity. Skeletal Radiol 2023; 52:855-874. [PMID: 35930079 PMCID: PMC9362560 DOI: 10.1007/s00256-022-04139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.
Collapse
Affiliation(s)
- Gunjan Malhotra
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Barry G. Hansford
- grid.5288.70000 0000 9758 5690Department of Radiology, Oregon Health & Science University, 3181 SW Jackson Park Rd., Portland, OR 97239 USA
| | - Cindy Felcher
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Kristie A. Wuerfel
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Corrie M. Yablon
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| |
Collapse
|
2
|
Labmayr V, Eckhart FJ, Smolle M, Klim S, Fischerauer SF, Bernhardt G, Seibert FJ. [Sterile puncture of large joints]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:65-80. [PMID: 36648491 PMCID: PMC9894986 DOI: 10.1007/s00064-022-00786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory. INDICATIONS The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions. CONTRAINDICATIONS If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants. SURGICAL TECHNIQUE Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas. POSTOPERATIVE MANAGEMENT Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma. FACTS If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.
Collapse
Affiliation(s)
- Viktor Labmayr
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | | | - Maria Smolle
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Sebastian Klim
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Stefan Franz Fischerauer
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Gerwin Bernhardt
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| | - Franz Josef Seibert
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, LKH-Univ. Klinikum Graz, Auenbruggerplatz 5, 8036 Graz, Österreich
| |
Collapse
|
3
|
Serfaty A, Jacobs A, Gyftopoulos S, Samim M. Likelihood of hip infection with image-guided hip aspiration dry tap: a 10-year retrospective study. Skeletal Radiol 2022; 51:1947-1958. [PMID: 35359220 DOI: 10.1007/s00256-022-04046-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the rate of infection in patients with suspected hip septic arthritis who underwent image-guided aspiration (IHA) resulting in dry-tap, diagnostic value of subsequent lavage and re-aspiration, and if pre-aspiration MRI can help prevent a dry tap. MATERIALS AND METHODS Retrospective review between 2010 to 2020 identified native hip (NH) and total hip arthroplasty (THA) patients who had a dry-tap following aspiration for suspected infection or periprosthetic joint infection (PJI). Serology tests, lavage/re-aspiration volumes, and aspirate cell-count/culture were assessed. On pre-aspiration MRI, presence/grade of joint effusion (JE), pseudocapsule dehiscence (PD), extraarticular fluid and sinus-tract were recorded. RESULTS Out of 215 included dry-taps, 185 (86.0%) were non-infected and 30 (13.9%) infected. In subgroup analysis, 64/71(90.1%) NH and 121/144(84.0%) THA dry-taps were non-infected. Pre-aspiration MRI of THA group with dry-tap showed significant findings; PD with extraarticular fluid (8/12, 66.7%) and sinus tract (7/12, 58.3%) were higher in the infected compared to non-infected group (5/42, 11.9% and 0/42, 0.0%) (both p < 0.001). Among THA group, polymorphonuclear-leukocytes > 80% was present in 8/9 (88.9%) of infected versus 4/28 (14.3%) non-infected group (p < 0.001). Multivariable regression showed PD (p = 0.005) and JE (p = 0.042) being significant independent predictors of PJI, similarly the elevated CRP (p = 0.044) and JE (p = 0.017). CONCLUSION Majority of patients suspected of hip joint infection with dry-tap were non-infected. Synovial PMN% following lavage maintains high sensitivity for detection of PJI. In patients with THA, PD and subsequent extraarticular collection can be associated with dry-tap therefore, pre-aspiration MRI can help determine their presence and plan the aspiration.
Collapse
Affiliation(s)
- Aline Serfaty
- Department of Radiology, Faculty of Medicine, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Medscanlagos Radiology, rua Manoel Francisco Valentim, 57, Cabo Frio, RJ, 28906220, Brazil.
| | - Adam Jacobs
- NYU Langone Medical Center, New York University, New York, NY, USA
| | | | - Mohammad Samim
- NYU Langone Medical Center, New York University, New York, NY, USA
| |
Collapse
|
4
|
Roberts CC, Metter DF, Fox MG, Appel M, Jawetz ST, Morrison WB, Nacey N, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Shoulder Arthroplasty: 2021 Update. J Am Coll Radiol 2022; 19:S53-S66. [PMID: 35550805 DOI: 10.1016/j.jacr.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
Shoulder arthroplasty is a common orthopedic procedure with a complication rate reported to be as high as 39.8% and revision rates as high as 11%. Symptoms related to postoperative difficulties include activity-related pain, decreased range of motion, and apprehension. Some patients report immediate and persistent dissatisfaction, although others report a symptom-free postoperative period followed by increasing pain and decreasing shoulder function and mobility. Imaging plays an important role in diagnosing postoperative complications of shoulder arthroplasties. The imaging algorithm should always begin with radiographs. The selection of the next imaging modality depends on several factors, including findings on the initial imaging study, clinical suspicion of an osseous versus soft-tissue injury, and clinical suspicion of infection.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Michael G Fox
- Panel Chair, Musculoskeletal Division Chair and Diagnostic Radiology Program Director, Mayo Clinic Arizona, Phoenix, Arizona
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons; and liaison with AOOS
| | - Shari T Jawetz
- Director, Radiology Quality Assurance; Director, Radiology Resident and Medical Student Education; and Chief, Division of Body CT, Hospital for Special Surgery, New York, New York
| | - William B Morrison
- Director, Division of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; ACR education center faculty; ACR AIRP faculty; ACR CPI author
| | - Nicholas Nacey
- Fellowship Director, Imaging Center Medical Director, University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas Said
- Medical Director of MRI Duke University Health System, Access Champion Department of Radiology, Director of Musculoskeletal Intervention, Duke University Medical Center, Durham, North Carolina
| | - James D Stensby
- MSK Imaging Fellowship Director, University of Missouri Health Care, Columbia, Missouri
| | - Naveen Subhas
- Vice Chair of Clinical Effectiveness and Efficiency, Imaging Institute Program Director, Musculoskeletal Radiology; and Director, Bone Mineral Densitometry, Cleveland Clinic, Cleveland, Ohio
| | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland; Past President of the Penn State College of Medicine Faculty Organization, ACR local chapter PRS President Elect
| | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | |
Collapse
|
5
|
Lee KC, Ahn KS, Kang CH, Hong SJ, Kim BH, Shim E. A Systematic Approach to Diagnosing Arthritis Based on Radiological Imaging. Curr Med Imaging 2022; 18:1160-1179. [DOI: 10.2174/1573405618666220428100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022]
Abstract
:
Radiology plays key roles in diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis while productive disease includes osteoarthritis, and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologist to diagnose arthritis.
Collapse
Affiliation(s)
- Kyu-Chong Lee
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Suk Joo Hong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Euddeum Shim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| |
Collapse
|
6
|
Kim SJ, Cho YJ. Current Guideline for Diagnosis of Periprosthetic Joint Infection: A Review Article. Hip Pelvis 2021; 33:11-17. [PMID: 33748021 PMCID: PMC7952269 DOI: 10.5371/hp.2021.33.1.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
The nature of implant-related infections is complex. Currently, there is no definitive test for periprosthetic joint infection (PJI) and diagnosis remains challenging despite recent developments. Failure to diagnose and investigate pathologies of the hip appropriately results in delayed management and prolonged patient morbidity. A systematic approach to establishing clear diagnostic criteria for PJI is needed to improve our ability to avoid devastating outcomes associated with these infections. In the current review, we describe an algorithmic approach to the diagnosis of PJI and current controversies surrounding novel diagnostic methods.
Collapse
Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| | - Yun Jae Cho
- Department of Orthopaedic Surgery, Hanil General Hospital, Seoul, Korea
| |
Collapse
|
7
|
Zulfiqar M, Menias C, Shetty A, Ludwig DR, Rehman SSU, Orlowski H, Mellnick V. Imaging Spectrum of Infections in the Setting of Immunotherapy and Molecular Targeted Therapy. Curr Probl Diagn Radiol 2020; 51:86-97. [PMID: 33272723 DOI: 10.1067/j.cpradiol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Advances in genomics and immunology are revolutionizing our understanding and treatment of cancer with improved treatment outcomes and patient quality of life. With the increasing use of immunotherapy and molecular targeted therapy, a variety of unusual and/or opportunistic infections are also observed. A variety of factors including use of immunosuppression for immune-mediated adverse effects play an important role for increasing the likelihood of these infections and form the basis of this case-based review. Imaging features of infections arising in patients undergoing immunotherapy regimens have not been previously highlighted. Prompt recognition of the spectrum of mycobacterial, bacterial, invasive fungal and viral pathogens can potentially lead to reduction in the high morbidity and mortality in this patient population.
Collapse
Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
| | - Christine Menias
- Mayo Clinic School of Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sana Saif Ur Rehman
- Department of Hematology Oncology, Washington University School of Medicine, St Louis, MO
| | - Hilary Orlowski
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| |
Collapse
|
8
|
Patitsas P, Davis R, Strony R. Point-of-Care Ultrasound-Directed Evaluation of Elbow Effusion. Clin Pract Cases Emerg Med 2019; 3:286-288. [PMID: 31404345 PMCID: PMC6682234 DOI: 10.5811/cpcem.2019.5.41674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022] Open
Abstract
A 53-year-old male presented with pain in the right elbow that was sudden in onset and progressively worsening over approximately eight hours. The pain was exacerbated with any movement of the elbow. Of note, he had been recently admitted for robotic prostatectomy and had a prolonged hospital stay requiring a course of antibiotics. This case report details the emergency department evaluation of septic arthritis of the elbow with a focus on best practices for ultrasound- guided elbow arthrocentesis.
Collapse
Affiliation(s)
- Peter Patitsas
- Geisinger Medical Center, Department of Emergency Medicine, Danville, Pennsylvania
| | - Richard Davis
- Geisinger Medical Center, Department of Emergency Medicine, Danville, Pennsylvania
| | - Robert Strony
- Geisinger Medical Center, Department of Emergency Medicine, Danville, Pennsylvania
| |
Collapse
|
9
|
Porrino J, Richardson ML, Flaherty E, Albahhar M, Ha AS, Mulcahy H, Chew FS. Septic Arthritis and Joint Aspiration: The Radiologist's Role in Image-Guided Aspiration for Suspected Septic Arthritis. Semin Roentgenol 2019; 54:177-189. [PMID: 31128740 DOI: 10.1053/j.ro.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jack Porrino
- Yale School of Medicine Radiology and Biomedical Imaging, 20 York Street, New Haven, CT 06510.
| | | | - Erin Flaherty
- Kaiser Permanente Washington Medical Group, Tacoma, WA
| | - Mahmood Albahhar
- Niagara Health-St Catharines Hospital, McMaster university, St Catharines, ON, Canada
| | - Alice S Ha
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Felix S Chew
- Department of Radiology, University of Washington, Seattle, WA
| |
Collapse
|
10
|
Accelerating recovery from acute hemarthrosis in patients with hemophilia: the role of joint aspiration. Blood Coagul Fibrinolysis 2019; 30:111-119. [PMID: 30958454 DOI: 10.1097/mbc.0000000000000803] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
: Arthrocentesis of an acute hemarthrosis in hemophilia remains a controversial issue. The purpose of this study is to define the role that joint aspiration can play in the recovery from acute hemarthrosis in patients with hemophilia. The study sample included 33 hemophilic patients (55 joints) with acute elbow, knee, and ankle hemarthrosis as confirmed by ultrasonography. Patients were distributed into a treatment group and a control group. Patients in the first group were subjected to joint aspiration, whereas patients in the second were not. Arthrocentesis was carried out immediately after diagnosis of acute hemarthrosis in liquid phase. Patients were infused with the deficient coagulation factor and were instructed to observe relative rest until resolution of hemarthrosis. The following parameters were analyzed: time to full resolution of hemarthrosis (determined by ultrasonography), duration of treatment with the deficient coagulation factor, time to pain relief, time to recovery of prebleed range of motion, and time to resumption of school/work (all of these measured in days). The joints treated with joint aspiration exhibited a significantly faster resolution of bleeding (fewer days). In addition, this group required fewer days of pharmacological treatment, with faster achievement of functional recovery and resumption of school/work activities. No complications were observed. This study shows that joint aspiration under hemostatic cover and in strictly aseptic conditions is a well-tolerated technique that makes the recovery of acute hemarthrosis of hemophilic patients faster.
Collapse
|
11
|
De la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Point-of-care Ultrasonography in Orthopedic Management of Hemophilia: Multiple Uses of an Effective Tool. HSS J 2018; 14:307-313. [PMID: 30258338 PMCID: PMC6148577 DOI: 10.1007/s11420-018-9604-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
Abstract
Even in our current era of hemophilia prophylaxis, articular complications can arise and there is a growing need for strategies in the prevention, diagnosis, and treatment of hemophilic arthropathy, a significant contributor to disability in patients with hemophilia. One useful tool, point-of-care ultrasonography (POC-US), offers diverse diagnostic and therapeutic possibilities. This article reviews the literature on the uses of POC-US in hemophilia, including early diagnosis of joint damage, differential diagnosis of articular pain, follow-up of joint injury, and guidance for both arthrocentesis and intra-articular injection. Studies show that for patients with hemophilia, POC-US enhances diagnostic accuracy and targeted treatments. Further research is required into the most efficient use of POC-US and the training needed to develop clinicians' skills. The attributes of POC-US should be understood more fully to enable its widespread application.
Collapse
Affiliation(s)
| | - E. Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital–IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | | |
Collapse
|
12
|
Abstract
Imaging is often used to establish a diagnosis of musculoskeletal infections and evaluate the full extent and severity of disease. Imaging should always start with radiographs, which provide an important anatomic overview. MRI is the test of choice in most musculoskeletal infections because of its superior soft tissue contrast resolution and high sensitivity for pathologic edema. However, MRI is not always possible. Alternative imaging modalities including ultrasound scan, computed tomography, and radionuclide imaging may be used. This article reviews the individual imaging modalities and discusses how specific musculoskeletal infections should be approached from an imaging perspective.
Collapse
Affiliation(s)
- Claus S Simpfendorfer
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, CCLCM/CWRU, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
13
|
Porrino J, Carlson B, Kani KK, Mulcahy H, Wyatt A, Chew FS. Disappearing Acts: The Many Causes of Rapidly Destructive Arthritis. Curr Probl Diagn Radiol 2017; 46:63-73. [DOI: 10.1067/j.cpradiol.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/24/2016] [Indexed: 01/12/2023]
|
14
|
Gyftopoulos S, Rosenberg ZS, Roberts CC, Bencardino JT, Appel M, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Hochman MG, Jacobson JA, Mintz DN, Newman JS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty. J Am Coll Radiol 2016; 13:1324-1336. [PMID: 27814833 DOI: 10.1016/j.jacr.2016.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
|
15
|
|
16
|
Abstract
With advances in imaging technology, there has been a significant increase in the number and range of interventional musculoskeletal image-guided procedures. One of the most commonly performed image-guided musculoskeletal interventions is the diagnostic and therapeutic percutaneous aspiration and drainage of multiple types of intra-articular, juxta-articular, and intramuscular pathologic fluid collections. These procedures may be performed under fluoroscopic, ultrasound, computed tomography, or even magnetic resonance guidance depending on the location to be accessed, type of pathology, patient characteristics, and operator preference. Musculoskeletal image-guided aspiration and drainage procedures are minimally invasive and generally very safe while offering valuable diagnostic information as well as therapeutic benefit. This article focuses on the appropriate indications, contraindications, and general technique for accessing the major joints via imaging guidance. For each joint, we discuss pertinent anatomy, appropriate imaging modalities, and preferred approaches to gaining intra-articular access. Additionally, the article discusses some of the more frequently encountered juxta-articular and intramuscular fluid collections that can be accessed and aspirated via percutaneous intervention, with mention of the importance of recognizing extremity sarcomas that can mimic these benign collections.
Collapse
Affiliation(s)
- Barry Glenn Hansford
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | | |
Collapse
|
17
|
Sara Muñoz C. Procedimientos intervencionales musculoesqueléticos. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|