Floating fat in the wrist joint and in the tendon sheaths

A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture.     

创伤性膝关节脂血症和血症的影像诊断

目的 探讨膝关节脂血症和血症的X线平片、CT、MRI、超声的影像表现及其诊断价值.方法 对经手术(27例)或穿刺(3例)证实的关节血症(12例)及脂血症(18例)的仰卧位水平摄影X线平片(16例)、CT(30例)、MRI(30例)、超声(24例)4种影像检查方法和结果进行研究.结果 (1)X线平片:9例脂血症中8例见脂-液平面,1例脂血症和7例血症见髌上囊密度增高,与肌肉近似.正确诊断骨折13例.(2)CT:18例脂血症中双液-液平面11例,单液·液平面7例.12例血症中3例见单液-液平面.9例呈中等密度,4例见卵圆形稍高密度血凝块.30例均正确诊断骨折.(3)MRI:18例脂血症中12例呈双液-液平面,上层呈短T1、长T2高信号及压脂像低信号,中层呈长T1、长T2信号及压脂像高信号,下层呈中等T1、T2信号及压脂像较高信号;6例呈单液-液平面.12例关节血症仅见上述的中、下2层.4例见边缘光滑的血凝块,在T1WI呈中等信号或中等信号伴高信号环,压脂像呈高信号,T2WI及压脂像呈中等或稍高信号伴低信号环.30例均正确诊断骨折.(4)超声:14例脂血症中双液.液平面10例,上层呈中等回声,中层无回声,下层呈云雾状回声;单液-液平面4例.10例关节血症中3例见单液-液平面,即仅见上述的中、下2层;7例呈云雾状回声并见漂浮状物.3例血凝块呈低-等回声类实性团块.均未见骨折线.结论 CT能很好地显示骨折线及关节脂血症和血症,可以替代X线平片.MRI是该病的最佳影像检查方法.超声可诊断关节脂血症和血症,但不能显示骨折.     

Acute knee trauma: role of ultrasound

The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.     

创伤性关节积脂血征的CT及MRI诊断

目的 分析创伤性关节积脂血征的CT及MRI表现特点，探讨CT及MR／对创伤性关节积脂血征的诊断价值。方法 回顾性分析50例创伤性关节积脂血征患者的CT及MRI的影像学特征。其中膝关节36例、髋关节8例、肘关节4例及肩关节2例。所有患者均于受伤后1h至4d内行CT及MRI检查。结果 50例创伤性关节积脂血征患者均存在关节内骨折，创伤性关节积脂血征的CT及MRI表现为在关节囊内特征性的单液-液平面或双液-液平面积液征象。其中22例表现为单液-液平面积液征象，28例表现为双液-液平面积液征象。构成单液-液平面上、下2层液体和双液-液平面的上、中、下3层液体有明显不同的CT值和所有扫描序列中MRI信号强度。结论 创伤性关节积脂血征的CT及MRI检查均有特征性表现，CT及MRI检查可明确诊断创伤性关节积脂血征，创伤性关节积脂血征与关节内骨折并存，可以作为关节内骨折的可靠的间接征象。     

Value of sonography and computerized tomography in pelvic tumors in the female. Prospective comparative study of 132 surgically treated pelvic space-occupying lesions

Clinical examination, ultrasonography and computed sonography were compared in a prospective study to establish their relative value in the diagnosis of space-occupying lesions in the female pelvis; 132 surgically excised lesions were examined with reference to the preoperative diagnoses made by all three methods. In the case of tumors of the ovary, the fallopian tubes and the corpus uteri, ultrasonography and computed tomography were found to yield information of approximately equal diagnostic value with reference to the site and extent of the tumor, the organ or organs affected and the consistency of the tumor. The two procedures were significantly more accurate than clinical examination, and to some extent they proved to complement each other. In contrast, computer tomography and ultrasonography proved to be inferior to clinical examination in the detection of tumors of the cervix.     

Case examples of rare locations of aneurysms

We describe four cases of rare aneurysm localisations, one case of an aneurysm of the hepatic artery, two cases of aneurysms of the superior mesenteric artery and its branches and, as an extreme rarity, one case of an aneurysm of the superior gluteal artery (only three known cases up to now). All cases were documented by arteriography/DSA, ultrasonography and computed tomography. We refer to incidence, aetiology, symptomatology, and possible complications as indicated by literature.     

Ultrasonography of hip joint effusions

In order to evaluate ultrasonography in patients with suspected hip joint effusions, 123 consecutive patients were examined prospectively. Twenty healthy subjects were used as a control group. The normal sonoanatomy, the recommended scanning approach, and the diagnostic features of intra-articular joint effusions are presented. Even minor fluid collections of 1 or 2 ml could be accurately detected. Transient synovitis and fresh hemorrhagic effusions proved to be echofree, whereas clotted hemorrhagic collections or septic arthritis showed non-echofree effusions. Based on intraoperative and computed tomography (CT) data, ultrasonography is clearly superior to X-ray films in detecting joint effusions. A negative sonogram will exclude a fluid collection; the depiction of an echofree effusion with virtually rule out septic arthritis. The use of additional imaging techniques can be reduced greatly, as ultrasonography seems to be an improved method for the early diagnosis of septic arthritis.     

Pseudotumoral ganglion cyst of a finger with unexpected remote origin: multimodality imaging

The case of a ganglion cyst in the pulp of a fifth finger in an elderly woman initially mimicking a soft tissue tumor is described. Most typical sites of ganglion cysts are well documented at the wrist and in the vicinity of inter-phalangeal and metacarpo-phalangeal joints. In this case, ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated a cystic lesion within the pulp of the fifth finger and indicated carpal osteoarthritis as the distant—and unexpected—origin of the lesion. The suggested diagnosis of ganglion cyst was confirmed by computed tomography arthrography (CT arthrography) of the wrist, which showed opacification of the cyst on delayed acquisitions after intra-articular injection into the mid-carpal joint, through the fifth flexor digitorum tendon sheath. The communications between the degenerative carpal joint, the radio-ulnar bursa, the fifth flexor digitorum tendon sheath and the pedicle of the cyst were well demonstrated.     

Mesenteric cyst with atypical computed tomography appearance

A case of mesenteric chylous cyst containing an unusual fluid-fluid level demonstrated on computed tomography but not on ultrasonography is presented.     

Chronic volvulus of an ectopic spleen with subcapsular hematoma. CT x-ray aspect

The authors present a case of ectopic spleen complicated by chronic torsion and subcapsular haematoma in an asymptomatic patient. The value of ultrasonography and computed tomography in the diagnosis of these complications is discussed.     

Occult prostatic abscess detected by transrectal sonography and computed tomography. Case report.

The authors report a case of prostatic abscess in a patient without significant clinical manifestation. Transrectal ultrasonography and computed tomography demonstrated a lesion suggestive of an abscess which was finally confirmed by transurethral resection revealing pus.     

The double fat fluid level: Lipohemarthrosis of the knee associated with suprapatellar plica synovialis

Lipohemarthrosis is a frequent occurrence following intrarticular fracture. The contour of the fat and blood interface in the knee joint is dependent upon suprapatellar anatomy. Anatomic variations of the suprapatellar joint space can significantly alter the radiographic appearance of lipohemarthrosis. Three cases are presented in which a double fat-fluid level was identified, due to presence of a well developed suprapatellar plica synovialis. Recognition of the variable appearance of lipohemarthrosis of the knee is important to avoid overlooking this finding in the traumatized patient.     

Computed tomography arthrography in traumatic hip dislocation

The newer diagnostic modalities such as computed tomography and magnetic resonance imaging are becoming increasingly used in the evaluation of joint trauma. The combination of computed tomography and arthrography can also be of significant diagnostic value in certain specific situations. In our case report, we describe its use in post-traumatic recurrent hip dislocation and its value, not only in depicting a posterior capsular tear, but also in the diagnosis of an internal joint derangement which may contribute to incongruous reduction of the hip joint.     

Intratumoral pseudoaneurysm: atypical radiologic manifestation of bleeding from an angiomyolipoma

We present the case of a patient with tuberous sclerosis and multiple bilateral renal angiomyolipomas (AML) who developed an intralesional pseudoaneurysm in the context of bleeding from an AML. The diagnosis was reached by ultrasonography and computed tomography, and the histological diagnosis of a contained hematoma confirmed the bleeding.     

Imaging assessment of enthesitis in spondyloarthritis

Enthesitis, defined as the inflammation of the origin and insertion of ligaments, tendons, aponeuroses, annulus fibrosis, and joint capsules, is a hallmark of spondyloarthritis (SpA). New imaging techniques including magnetic resonance imaging (MRI), ultrasonography, and positron emission tomography with computed tomography using ¹⁸F-fluorodeoxyglucose capable of detecting morphological and metabolic abnormalities and monitoring disease activity have improved the assessment and management of enthesitis of SpA.     

Value of diffusion-weighted magnetic resonance imaging in the diagnosis of pyomyoma

Pyomyomas are rare lesions that develop from the suppurative degeneration of ischemic leiomyomas. Pyomyomas can lead to sepsis, so early diagnosis is crucial. Due to their rarity and often nonspecific findings on ultrasonography and computed tomography diagnosis is often delayed. We present a case of a woman who presented with abdominal pain and fever. The computed tomography showed a large hypodense uterine lesion with slight peripheral enhancement without gas in the lesion. The diffusion-weighted magnetic resonance imaging showed restricted diffusion, demonstrating the presence of pus and confirming the diagnosis of pyomyoma. Diffusion-weighted imaging should be done in cases of suspected pyomyomas when computed tomography findings are nonspecific.     

超声显像与CT对阻塞性 黄疸诊断的准确性比较(附56例病例分析)

目的:比较超声显像与CT诊断阻塞性黄疸的准确性,寻求最佳方法。材料与方法:本文讨论了56例经手术与病理证实为阻塞性黄疸的超声检查特点,并与CT诊断进行了比较。结果:良性病变28例,其中胆管结石18例,占64.1％,超声对其诊断符合率,与CT相同,均为100％。恶性病变28例,其中胆管癌17例,胰头癌6例,共占恶性病变的82.1％,超声对其诊断的符合率为100％,而CT的诊断符合率为95.7％。就梗阻部位的诊断符合率而言,超声高于CT,分别为92.9％(52/56)和85.7％(48/56)。对梗阻病因的诊断符合率也是超声高于CT,即分别为89.3％(50/56)和80.4％(45/56)。结论:超声显像对阻塞性黄疸的诊断明显优于CT,可作为诊断阻塞性黄疸的首选方法。     

Giant ameloblastoma

Ameloblastoma is the most frequent of the odontogenic tumors. We report a case of a giant ameloblastoma involving the maxillary region and describe its ultrasonography and computed tomography findings.     

Pitfalls in ultrasonography of hip joint synovitis in the child

The normal and abnormal anatomy of the hip joint in childhood was evaluated by ultrasonography (US) with reference to examination technique and errors. When compared with computed tomography (CT), it was confirmed that the two sonographic echoes from the hip joint represent the femoral neck and the external surface of the capsule and that the thickness of the echo received from the capsule depends on the frequency of the transducer. Partial volume effects may simulate or increase the sonographic appearance of hip joint effusion. The normal relationship between joint capsule and femoral neck was established.     

Isolated tuberculous involvement of a posterior vertebral arch. Value of x-ray computed tomography and puncture under ultrasonography for the diagnosis. Apropos of a case

A case relative to an isolated tuberculous lesion of a vertebral arch associated with a paravertebral abscess is reported. The authors insist on the rarity of this location. They underline the role of the computed tomography for the positive diagnosis and the precise extent of lesions and the interest of the biopsy under ultrasonography for the bacteriological and histological diagnosis.