Supraspinatous Ganglion Cyst MRI

xlomafota13 shared this article with you from Inoreader Supraspinatous Ganglion Cyst MRI Via Neuroradiology Cases Clinically severe painful restricted shoulder movement, especially the abduction. Patient complaining that symptoms aggravated with shoulder exercise and physiotherapy. No obvious history of arthroscopy or intra articular injection. This MRI shoulder joint shows a well-defined tear drop shaped cystic lesion along supraspinatus tendon tapering towards its insertion suggestive of Intra tendinous ganglion cyst. Associated changes of tendinosis involving supraspinatus tendon as there is mild tendon thickening.  There was no sub acromial spur or para labral cyst. Acromioclavicular joint normal. Managed conservatively with intra-articular steroid. Clinical follow-up mentioned that patient improved clinically with range of movement improved by approximately 75%. Suggested follow-up imaging Imaging diagnosis: intra tendinous ganglion cyst of supraspinatus tendon causing shoulder impingement. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Discoid Meniscus

xlomafota13 shared this article with you from Inoreader Discoid Meniscus Via Neuroradiology Cases This MRI study of knee joint shows discoid lateral meniscus. No obvious associated meniscal tear or para meniscal cyst. Discoid meniscus This is a congenital condition and is bilateral in about 50% of the cases. Usually found as an incidental finding on MRI examination in about 5% of the cases, typically affecting lateral meniscus. Discoid medial meniscus is very rare. The pathology behind  this discoid shape is loss of normal orientation of collagen fibres of meniscus. Frequently this is an asymptomatic condition however the discoid meniscus has propensity for cystic degeneration, tear and para meniscal cyst formation. In such cases patient may present with knee pain with or without locking.  MRI is the investigation of choice.  The width of the body of meniscus, if 15 mm or more on coronal section is diagnostic of discoid meniscus. The body of the lateral meniscus is normally has bowtie configuration on sagittal section and seen only on two consecutive slices. If the meniscal body is seen on three or more consecutive slices while scrolling the sagittal sections, instead of normal bowtie tie should alarm of discoid morphology.  The finding is usually managed conservatively if not symptomatic.  Partial or total resection is the option kept in front of patient if there is associated complication like tear. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Excessive lateral pressure syndrome MRI

xlomafota13 shared this article with you from Inoreader Excessive lateral pressure syndrome MRI Via Neuroradiology Cases  This MRI Axial STIR sections of knee show clinical marker on skin on anteromedial aspect of knee joint. There is patellar tilt, articulating surface of patella facing medially with abnormal thickening of lateral patellar retinaculum and patellofemoral ligament. Associated bone marrow oedema involving lateral margin of lateral articulating facet of patella. Imaging findings consistent with clinical diagnosis of Excessive lateral pressure syndrome. Lateral Patellar Compression Syndrome Synonym : Excessive lateral pressure syndrome, ELPS This is another common cause of anterior knee pain. The improper tracking of the patella in the trochlear groove generally caused by imbalance between medial and lateral dynamic stabilisers of knee, the tight lateral retinaculum restricting the patellar mobility with excessive lateral tilt of patella causing friction between lateral articulating facet of patella with lateral trochlea of femur. Typical ly affects adults, patient presents with pain on compression of the patella, lateral facet tenderness. Condition is aggravated physical activity. It's a mainly clinical diagnosis. However, lateral tilt of patella on axial sections of MRI or sunrise knee radiographs, patella facing medially without lateral translation should be depicted meticulously which is very commonly overlooked during MRI interpretation. Furthermore, abnormal thickening and shortening of lateral patellar retinaculum and lateral patellofemoral ligament could be appreciated on MRI. Nonetheless, the important ancillary findings on MRI are subchondral bone marrow oedema, cystic geodes involving lateral articulating facet of patella and adjacent lateral femoral trochlea facing the patella. The patellofemoral angle is calculated on axial sections, the medial opening of the angle, that is demonstration of angle more than 8° can support the diagnosis of ELPS. Treatment is mainly conservative with Physiotherapy focusing on quadriceps stretching and strengthening. Operative lateral retinaculum release is reserved for refractory cases.  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Osteochondrosis of Superior Pole of Patella

xlomafota13 shared this article with you from Inoreader Osteochondrosis of Superior Pole of Patella Via Neuroradiology Cases Clinically young male patient with athletic background complaining of typical unilateral anterior knee pain. Marked tenderness at the superior pole of patella. This MRI study of knee joint shows abnormal irregularity, fragmentation with sclerosis involving superior pole of patella with thickening of quadriceps tendon. Associated knee joint effusion. Imaging findings consistent with osteochondrosis of patella at superior pole. Osteochondrosis of the superior pole of the patella Osteochondroses are a heterogeneous group of injuries to the epiphyses and apophyses of children or adolescents, are actually osteonecrosis repetitive microtrauma and avulsion injuries. Imagingwise characterized by bone fragmentation and sclerosis. There are two well-known such syndromes associated with knee joint one is Osgood-Schlatter disease, an avulsion of the tibial tuberosity and another is Sinding-Larsen-Johansson disease, a chronic avulsion injury of the lower pole of the patella at the insertion of patellar t endon. The less well described osteochondrosis at the superior pole of patella appears secondary to similar mechanism associated with quadriceps tendon insertion, a rare cause of anterior knee pain in children between 5 and 9 years of age, usually affects the single knee but bilateral cases have also been reported. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Morel-Lavallée lesion MRI

xlomafota13 shared this article with you from Inoreader Morel-Lavallée lesion MRI Via Neuroradiology Cases Clinically RTA, run over by tractor. This MRI study shows a focal well defined lentiform shaped subcutaneous collection on medial aspect of knee joint superficial to the superficial fascia. Collection is clear, hypo intense on T1-weighted images without any septation or loculation. No obvious high signal intensity methaemoglobin staining on T1-weighted images to suggest any haematoma. Morel-Lavallée lesion These are focal well defined lentiform shaped subcutaneous serous collections commonly encountered during MRI knee joint in the setting of severe trauma. However these lesions are typically described in thigh as well defined collection overlying the greater trochanter of the femur, tensor facia lata.  These actually localized haemolymphatic collections secondary to closed degloving injuries, where the skin and subcutaneous fatty tissue abruptly separate from the underlying fascia owing to trauma. The potential space thus created superficial to the superficial fascia is filled by serous fluid, some times frank blood. Similar collection secondary to similar biomechanical forces are described in lumbar region and over the scapula as well.  The accumulated collection usually needs nothing to be done, resolves spontaneously. However may persist longer if gets organized and encapsulated. The conservative management is with compression bandages. Surgical drainage may be sufficient for larger collection. However, the capsule may need to be resected to prevent re-accumulation if it is long standing and encapsulated collection with thick organized wall.  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vitamin C deficiency mimicking inflammatory bone disease MRI hip

xlomafota13 shared this article with you from Inoreader Vitamin C deficiency mimicking inflammatory bone disease MRI hip Via Neuroradiology Cases A 15 years old school goer presented with on and off bilateral hip pain, restricted hip joint movement, associated backache.  MRI bilateral hip joint shows abnormal bone marrow edema involving bilateral acetabulum and subchondral portion of right sacral ala. Associated mild left hip joint effusion. Imaging finding were suggestive of either inflammatory bone disease or multifocal osteitis.  However the possibility of nutritional cause like Vit C or D deficiency was kept during discussion with the referring physician.  Accordingly to get the lab investigation done, was assured by refereeing doctor. Patients CBC, ESR, C-reactive protein was normal, RA factor was negative. Vitamin and mineral status showed normal zinc, folate and vitamin B6 levels. The vitamin C turned out strikingly low at 5 μmol/L (normal range 23–114 μmol/L) and vitamin D 25-OH at 12.2 ng/mL (normal > 30 ng/mL). Treatment was already initiat ed by refereeing doctor with ascorbic acid, cholecalciferol, and liquid meal supplements keeping the diagnosis of scurvy on the basis of severely low vitamin C levels.  The crucial message from such case is suggesting the nutritional cause for nonspecific bone marrow edema in MSK imaging is mandatory rather than confining our diagnosis between infective, inflammatory and neoplastic etiology all the time as in our case the treatable cause like Vitamin C deficiency was mimicking the inflammatory bone disease.  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The C-S Approach for The Management of Median or Paramedian Frontal Sinus Lesion

xlomafota13 shared this article with you from Inoreader The C-S Approach for The Management of Median or Paramedian Frontal Sinus Lesion Via Otolaryngology Indian Abstract The frontal sinus is one the most complex of the paranasal sinuses, its proximity to the cranial vault and the orbit cause that frontal sinus pathologies can progress to involve these structures and lead to significant morbidity, or even death. Surgical management of the frontal sinus is technically challenging, the most commonly used surgical approaches are coronal, butterfly, gullwing and suprabrow. The purpose of this article is to propose the C-S approach, an interesting alternative to the gullwing approach for the managing of median and paramedian frontal sinus lesions or isolated displaced fractures of the anterior wall. The main advantage of this technique is represented by the fact that it follows the new tension lines described in the literature, a curved vertical line that follows the glabellar frown. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of Depth of Invasion (According to Layer) on Lymph Node Metastasis in Buccal Mucosa Cancers

xlomafota13 shared this article with you from Inoreader Impact of Depth of Invasion (According to Layer) on Lymph Node Metastasis in Buccal Mucosa Cancers Via Otolaryngology Indian Abstract (1) To study layer of invasion as predictor of cervical lymph node metastasis. (2) To decide a cut off depth according to layer of invasion for neck dissection. It is a prospective study with sample size of 220 patients at tertiary care hospital with previously untreated operable buccal mucosa carcinoma over period of 21 months. The factors considered under the study were Tumor layer of invasion, lymph node metastasis, Ultrasonography doppler neck, CT scan and gender. Wide excision of the lesion and reconstruction was done. Histopathological analysis of resected specimen were recorded as part of data collection for all the cases. Quantitative data represented using Mean ± SD (Standard Deviation) and median and interquartile range compared using Chi square test. Standard principles of univariate analysis was used according to statistical methods. Depth when measured according to layer of invasion, was significantly associated with lymph no de metastasis with 89% of the muscle as layer of invasion being Lymph node positive (p = 0.009). There is 1.39 times chances of lymph nodal metastasis in patients with muscle invasion as compared to submucosal invasion. Tumour layer of invasion plays important role in predicting chances of nodal metastasis in clinically N0 neck in buccal mucosa cancer. According to the study, we should electively proceed with ipsilateral lymph node dissection once the layer of tumour invasion is muscle. This study is limited by sample size and short duration of one year and nine months. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effect of short radiation treatment breaks on chemo‐radiotherapy for oropharyngeal cancers

xlomafota13 shared this article with you from Inoreader The effect of short radiation treatment breaks on chemo‐radiotherapy for oropharyngeal cancers Via Head & Neck Abstract Background Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer. Methods In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses. Results Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks. Conclusions In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Initial Presentation of Granulomatosis with Polyangiitis as Progressive Skull Base Osteomyelitis

xlomafota13 shared this article with you from Inoreader Initial Presentation of Granulomatosis with Polyangiitis as Progressive Skull Base Osteomyelitis Via O.R.L. Journal for oto-rhino-laryngology and its borderlands A healthy man in his 30s presented with a 2-week history of severe bitemporal pain and pressure. He was initially treated for presumed acute rhinosinusitis, but his symptoms continued to worsen and underwent endoscopic sinus surgery at an outside community facility. He developed left abducens nerve palsy postoperatively, and magnetic resonance imaging (MRI) demonstrated evidence of extensive skull base osteomyelitis. He was initiated on intravenous (IV) broad-spectrum antibiotics but was subsequen tly found to have prostatic and submandibular sterile fluid collections. The patient subsequently developed new right abducens and left vagal nerve palsies and underwent revision endoscopic sinus surgery. Pathology revealed extensive inflammation, necrotizing granulomas, and evidence of small and medium vessel vasculitis. Extensive laboratory workup was negative, except for anti-PR-3 antibody positivity. Given the characteristic findings on pathology and laboratory findings, the patient was diagnosed with granulomatosis with polyangiitis (GPA). High-dose glucocorticoid therapy as well as rituximab infusion were promptly initiated. He had marked improvement in his symptoms and resolution of his right CN VI palsy but left-sided CN VI and CN X palsies persisted. This patient presented without the typical rhinologic manifestations of GPA, and rather presented with progressive sinusitis, skull base osteomyelitis with associated cranial neuropathies, and aseptic systemic abscesses. Prompt diagnosis of GPA is particularly important in those with otorhinolaryngological manifestations, as early initial immunosuppressive therapy has been linked to lower relapse and mortality rates. Vigilance and early differentiation between GPA and other forms of sinusitis is of critical importance, particularly when symptoms are refractory to standard rhinosinusitis therapies. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Office‐based Transnasal Oesophagoscopy: evaluating the safety, efficacy and application in head and neck cancer patients

xlomafota13 shared this article with you from Inoreader Office‐based Transnasal Oesophagoscopy: evaluating the safety, efficacy and application in head and neck cancer patients Via Clinical Otolaryngology Abstract Transnasal Oesophagoscopy (TNO) is an approach to inspect the upper aerodigestive tract, especially in the head and neck cancer (HNCA) population that present with dysphagia. Twenty-five (25) office-based TNO procedures were performed, with a same-day discharge rate of 96% (24/25) and no reported complications. This case series is the first to compare preoperative and postoperative outcomes (EAT-10) following stricture dilatation using TNO in the UK. Our results show a statistically significant improvement in symptom severity (EAT-10 scores) (n=11, P=0.001). Nearly half (45.5%) of patients undergoing dilatation developed strictures due to post-radiation/post-laryngectomy complications. Biopsy in 4/5 patients was sufficient for diagnosis/ruling out disease. Of these patients, 5/5 had a previous HNCA. This study identifies the remit for a new 'one-stop' TNO service for suspected cancer referrals, of which a large proportion are patients with a previous HNCA. Surveillance, therapeutics and diagnostics can be achieved in a single visit. Earlier staging or treatment may be achieved due to a fast turnover in clinic View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.