Giant pes anserinus bursitis: A rare soft tissue mass of the medial knee

Bursae are small, jelly-like sacs that are located throughout the body, mainly around the shoulder, elbow, hip, knee, and heel in a number over 150. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction. Pes anserinus bursae, despite being clinically frequent, are not visible either by ultrasound (US) or magnetic resonance image (MRI). In some cases, we may observe a small fluid collection. The present case-report demonstrates the full clinical picture of a giant pes anserinus bursae beginning from clinical observation to its final pathology exam.     

Pterygoid hamulus elongation syndrome

IntroductionPain in the soft palate and pharynx can originate from numerous related anatomical structures. Therefore, the diagnosis of patients who complain of pain in these areas is also difficult and challenging. One of the anatomic disorders that causes pain and discomfort in this region is pterygoid hamulus elongation syndrome.Presentation of caseWe report a rare case of pterygoid hamulus elongation with persistent sharp localized pain in the hamular region radiating to the temporal area for four years that was treated successfully by surgical resection of elongated hamulus.DiscussionPterygoid Hamulus elongation syndrome is a unique disease presenting many symptoms in the palatal and pharyngeal areas. May caused by injury, infection, or a pre-existing condition. The diagnosis of hamular elongation should be based on detailed history, clinical examination, and correlation with radiographic imaging.ConclusionDue to the rarity, PHE syndrome should be diagnosed accurately. Management of hamular elongation is either surgical or conservative but resection of the pterygoid hamulus is usually preferred.     

Bursectomy,Curettage, and Chemotherapy in Tuberculous Trochanteric Bursitis

We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.     

A typical case of bursitis

A 66-year-old man with pain and swelling of the left elbow is presented. The elbow was severely disfigured as a result of a childhood trauma in the Second World War. After 60 years without complaints, he presented with what was initially diagnosed as bursitis. After surgical treatment, a large wound dehiscence occurred. The defect was reconstructed microsurgically using a free-flap of the latissimus dorsi muscle and skin graft. Reconstructive surgery led to a satisfactory functional result.     

Hemorrhagic prepatellar bursitis

 Simple prepatellar bursitis is easily diagnosed both clinically and by MRI. MRI shows the typical T1 and T2 lengthening of fluid within the bursa. However, because of complex MRI appearance of hemorrhage, chronic hemorrhagic bursitis and the size of the prepatellar mass the clinical and MRI appearance can be very different.     

超声在滑囊炎诊断中的应用

本文对７０例四肢大关节处滑囊炎进行定位诊断，其中肘部３例，臀部２例，膝前部２０例，窝部４４例，足踝部１例，均经手术、穿刺及病理证实。超声诊断与手术符合率９７．６％。本组讨论滑囊炎的影像表现及滑囊与关节腔的关系，认为根据滑囊炎的定位诊断，对治疗方案及手术入路的选择有重要意义。     

Technical aspects and value of arthrosonography in rheumatologic diagnosis. 4: Ultrasound of the elbow

Musculoskeletal ultrasonography is an important imaging technique in the diagnosis of rheumatic diseases especially for early manifestation. It allows sensitive detection of small joint fluid collections as well as differentiation of soft tissue lesions and bone lesions. The following standard scans are suggested for sonographic evaluation of the elbow: 1) anterior humeroradial longitudinal scan, 2) anterior humeroulnar longitudinal scan to detect effusions, synovial proliferation, loose joint bodies, bone lesions (osteoarthritis/arthritis), 3) anterior transverse scan over the trochlea to evaluate these structures in an additional dimension, 4) posterior longitudinal scan and 5) posterior transverse scan of the olecranon fossa with flexed/extended elbow to evaluate the same objectives as the above mentioned scans and additionally to detect olecranon bursitis, and optional 6) distal dorsal longitudinal scan to differentiate soft tissue lesions such as rheumatoid nodules or gout tophi, 7) anterior transverse scan over the radius head to evaluate lesions of the radius head, tendopathy, calcinosis, 8) lateral humeroradial longitudinal scan to evaluate epicondylitis, 9) medial humeroulnar longitudinal scan to evaluate calcinosis, epicondylitis, signs of compression of the ulnar nerve. A linear transducer with a frequency of about 5-7.5 MHz is recommendable. The anterior distance between trochlea and the capitulum of the humerus between the bone and the joint-capsule of the elbow is > or = 2 mm in probable and > or = 3 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between the right and left elbow is 1 mm, and they are definite if the difference is > or = 2 mm.     

Value of arthrosonography in early arthritis diagnosis

Sonography of joints and peri-articular soft tissue has become an established imaging technique for the diagnosis and follow-up of patients with rheumatic diseases. Sonography allows a good differentiation of exsudative and proliferative changes of synovialis as well as tenosynovitis. Superficial cartilage and bony lesions may be seen before they are apparent on x-rays. Sonography is helpful in the diagnosis of early arthritis. Dynamical examination of joints allows the detection of structural abnormalities. Sonography can also be used for interventional procedures such as joint aspirations, guidance of therapy and needle biopsy.     

Septic bursitis in systemic lupus erythematosus

Summary Septic olecranon bursitis developed in three patients with systemic lupus erythematosus. Although promptly treated with systemic antibiotics, the clinical course in two patients became prolonged and eventually required bursectomy to eradicate the infection. The occurrence of septic bursitis was a manifestation of the general susceptibility of SLE patients to infections.