Diverging gastro-esophageal folds: an useful sign for detecting small hiatal hernias in the erect position

Upright, double contrast films of the gastro-esophageal junction were reviewed in 30 patients with hiatal hernias and 30 normal controls. Patients with hiatal hernias demonstrated gastro-esophageal folds that converged above the diaphragm and diverged at or beneath the diaphragm on double contrast films of the esophagus. In the normal situation these folds were found to converge at or beneath the diaphragm. The origin and significance of this sign for the diagnosis of hiatal hernias in the upright position is discussed.     

Cardiac levorotation: a cause of false-positive epicardial fat pad sign

In a 60-year-old man, two chest radiographs showed an apparently thickened pericardial stripe. Echocardiography and surgery for aortic valve replacement showed no pericardial fluid or thickening. An angiocardiogram showed that the patient's right coronary artery was positioned more medially than usual because of levorotation of the heart, producing the false-positive fat pad sign.     

Quadriceps fat pad edema: significance on magnetic resonance images of the knee

Objective While clinically reading magnetic resonance (MR) images of the knees we have occasionally noted edema within the suprapatellar fat pad, with mass effect both on the suprapatellar joint recess posteriorly, and on the quadriceps tendon anteriorly. This MR appearance is analogous to Hoffa’s disease described in the infrapatellar fat pad. We sought to evaluate the frequency and pattern of this finding and to provide clinical and histological correlation. Patients The suprapatellar (quadriceps) fat pad was evaluated in 770 consecutive MR examinations (on 1.5 T and 0.3 T) in 736 patients (353 females and 383 males, age range 5–86 years, mean 44.3 years). Design The MR images were retrospectively evaluated by two observers in consensus for the presence of quadriceps fat pad edema with mass effect. In 46 patients who had intravenous administration of gadolinium, the presence of enhancement was also evaluated. Clinical correlation was performed in abnormal cases; in one patient, 1-year follow-up MRI was evaluated and in one patient a percutaneous biopsy as well as 2-year clinical follow-up was performed. Results Thirty-two (4.2%) knees in 29 patients showed quadriceps fat pad edema and mass effect. In five of these patients imaging of the contralateral knee was also performed and four of these showed symmetric edema. Another five cases had gadolinium-enhanced images with prominent enhancement. Most patients had clinical symptoms of meniscal tears (n=16, 55%) or anterior knee pain (n=8, 27.6%). The remainder had nonspecific pain (n=4, 13.8%) or suspected avascular necrosis (n=1, 3.4%). In the case with 1-year follow-up MRI, improvement was seen. Biopsy in another patient revealed vasculitis with obliteration of the small vessels. Resection of the fat pad in this patient led to complete resolution of the symptoms. Conclusion Suprapatellar fat pad edema may be analogous to Hoffa’s disease, is rare, and may be a cause of anterior knee pain. However, this finding is not infrequent and its precise association with symptoms remains unclear. The study was done when all authors worked at Thomas Jefferson Medical College.     

The fat pad sign following elbow trauma in adults: its usefulness and reliability in suspecting occult fracture

OBJECTIVE: An elbow joint effusion with no fracture seen on radiographs after acute trauma has become synonymous with occult fracture. This study evaluates the incidence of fracture in such cases as determined by MR imaging and the predictive value of an elbow joint effusion. METHODS: Twenty consecutive patients whose posttrauma elbow radiographs showed an effusion but no fracture and who were suitable for MR imaging were recruited. The elbow effusion size, represented by anterior and posterior fat pad displacement, was measured from the initial lateral elbow radiograph. Suitable candidates underwent MR imaging using a bone marrow sensitive sequence. The time between injury and MR imaging ranged from 0 to 12 days (mean 4 days). RESULTS: Seventy-five percent of the 20 patients who underwent MR imaging had radiographically occult fractures identified. Some (86.6%) of these fractures were located in the radial head, 6.7% were in the lateral epicondyle, and 6.7% were in the olecranon. Ninety percent had evidence of bone marrow edema. Fifteen percent had collateral ligament disruption identified on MR imaging, and 5% had a loose body. There was no change in patient management as a result of the additional imaging. The anterior fat pad displacement ranged from 5 to 15 mm (mean 9.25), and the posterior fat pad was elevated from 1 to 6 mm (mean 3.2). CONCLUSION: Our data using MR imaging suggests that fat pad elevation in the presence of recent trauma is frequently associated with a fracture. The size of the effusion, anterior/posterior fat pad elevation, or a combination of both does not correspond to the likelihood of an underlying fracture. MR imaging reveals a broad spectrum of bone and soft tissue injury beyond that recognizable on plain radiographs as demonstrated by all patients in this study.     

Down syndrome: sonographic sign for diagnosis in the second-trimester fetus

In an expanded series of patients a sonographic sign was found to correlate well with the diagnosis of Down syndrome in second-trimester fetuses. The sign is characterized by soft-tissue thickening at the back of the fetal occiput. Sonographic evaluation for this sign was done in 2,121 consecutive fetuses between 15 and 20 gestational weeks of age at the time of genetic amniocentesis. The mothers were 35 years old or older or were otherwise at increased risk for fetal trisomies. Ten fetuses had Down syndrome by karyotype and four of these (40%) had thickened soft tissues (6 mm or more) at the back of the neck or occiput. When these data are combined with those in series previously reported by the authors, similarly collected consecutively, total second-trimester fetuses studied equals 3,825. Nine of the 21 (42%) Down syndrome fetuses by karyotype from this 3,825 had the positive sonographic sign described.     

Gallbladder: common cause of antral pad sign.

An impression on the posteroinferior aspect of the gastric antrum is often caused by a mass lesion in the pancreas. However, the gallbladder more commonly causes such as indentation. In any case of this "antral pad sign", a gallbladder impression should first be excluded.     

Facet formation sign in sarcoidosis: a new sign in endoscopic ultrasonography

Endoscopic ultrasound was performed in 56 patients with histologically or clinically proven mediastinal or lung diseases. These 56 patients comprised 12 with sarcoidosis, 8 with lymphoma, 20 with lung cancer, 10 with oesophageal cancer, and 6 with other diseases. A 7.5 MHz electronic linear-arrayed ultrasonic endoscope was used. In 38 of the 56 patients lymph nodes were detected by endoscopic ultrasound. Eleven patients with sarcoidosis showed lymph nodes in a facet formation (like stones in an old stone wall), while lymph nodes in the other 27 patients were round in shape and did not form facets. The facet formation sign, evaluated by endoscopic ultrasound, may be a characteristic finding in sarcoidosis. Correspondence to: M. Mori     

Diagnostic significance of the CT rim sign in cases of gangrenous cholecystitis

PurposeTo evaluate the association between the CT rim sign and gangrenous cholecystitis (GC) and increased surgical difficulty.MethodPatients who had a contrast enhanced CT of the abdomen and pelvis, followed by non-elective cholecystectomy were analyzed. The scans were reviewed for the CT rim sign by radiologists blinded to the pathologic and clinical outcomes. Demographic and clinical characteristics were compared between patients with and without GC using t-tests or Wilcoxon ranked sum test for continuous variables, and Fishers' exact test for categorical variables, when appropriate. A logistic regression model was fitted with multiple risk factors. Odds ratios as well as 95% confidence intervals were then calculated for the risk factors. A secondary analysis predicting increased surgical difficulty, defined as an operative time of greater than 2 h or increased conversion rate to open surgery, was also examined.ResultsA total of 100 patients were included; 20 of which had GC. On imaging, patients with GC were more likely to have a CT rim sign (65% vs 32.5%, OR = 3.80, 95% CI: 1.24–12.7, p = 0.011). The presence of the CT rim sign did not reach a statistically significant association with an operative time >2 h or conversion to open case (56.52% vs 33.77%, OR = 2.55, p = 0.056).ConclusionThe CT rim sign can be utilized to raise the possibility of GC, however the presence of the CT rim sign does not demonstrate an association with increased surgical difficulty.     

Pericruciate fat pad of the knee: anatomy and pericruciate fat pad inflammation: cadaveric and clinical study emphasizing MR imaging

Objective

The pericruciate fat pad is located in the intercondylar fossa, intimate with the cruciate ligaments. With MR imaging, signal abnormality of the pericruciate fat pad has been observed in patients with posterior knee pain. The purpose of this study was to describe the anatomy of the pericruciate fat pad in cadaveric specimens and to document the clinical spectrum of pericruciate fat pad inflammation.

Materials and Methods

Twelve cadaveric knees underwent MR imaging with T1 and T2 multiplanar images. Cadaveric sections were then prepared for macroscopic evaluation, with additional histologic analysis performed in four cases. MR images in seventeen patients (ten males, seven females; average age, 31.5?years; age range, 19–57?years) involved in intensive sporting activity and with posterior knee pain were reviewed.

Results

MR images in cadaveric specimens showed a fat pad that was located above and between the cruciate ligaments, near their attachment sites in the inner portion of the femoral condyles, within the intercondylar fossa. Fatty tissue covered by a thin layer of synovial membrane was confirmed at histology. Seventeen patients with posterior knee pain and without gross cartilage, meniscal, or ligamentous abnormalities all revealed an increased signal in this fat pad in fluid-sensitive fat-suppressed images, mainly in the sagittal and axial planes. In eight cases, enhancement of this fat pad was demonstrated following intravenous gadolinium administration.

Conclusions

The pericruciate fat pad is a structure located in the intercondylar fossa, intimate with both the anterior and posterior cruciate ligaments. Inflammatory changes in this fat pad may be found in patients, especially athletes with posterior knee pain.     

股四头肌脂肪垫和股前脂肪垫形态和信号特征与膝关节骨性关节炎的相关性研究

目的:探讨股四头肌脂肪垫(QFP)和股前脂肪垫(PFP)的形态和信号特征与膝关节放射学骨性关节炎(ROA)结构改变的关系.方法:回顾性分析纳入的60个临床资料齐全的膝关节X线和MRI检查图像资料,于矢状面PDW-SPAIR序列图像上定量测量QFP最大前后径、最大头尾径、最大斜径和最大面积及PFP的最大厚度.半定量评估Q...     

Extra-osseous fat fluid level: a specific sign for osteomyelitis

Osteomyelitis may pose as a diagnostic dilemma on various imaging modalities and may be confused with neoplasms and other pathology. Although a rare finding, extra-osseous fat fluid level, especially when associated with spongy bone destruction, can be considered a specific sign of osteomyelitis. Previously, only two cases of extra-osseous fat fluid level in osteomyelitis have been reported, one on computed tomography (CT) and the other on magnetic resonance imaging (MRI). The former was a case of septic arthritis with intra-articular fat fluid level. A case of osteomyelitis is presented with the demonstration of extra-osseous fat fluid level. Our case is unique in providing exquisite CT and MRI correlation.