The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

The Double-Line Sign: A False Positive Finding on the Focused Assessment with Sonography for Trauma (FAST) Examination

Background: Emergency physicians commonly perform Focused Assessment with Sonography for Trauma (FAST) examinations to evaluate for free intraperitoneal fluid. Many ultrasound findings can be misinterpreted as free fluid, resulting in false-positive FAST examinations. Objectives: To describe a previously unreported ultrasound finding that can be misinterpreted as free intraperitoneal fluid. Case Report: A 32-year-old man was stabbed in the left upper abdomen. A FAST examination was performed and a right perinephric fat pad was interpreted as showing free fluid in Morison's pouch. After transfer to a trauma center, a repeat FAST examination revealed no signs of intraperitoneal free fluid. Wound exploration showed no signs of penetration into the peritoneal cavity. Conclusions: When performing a FAST examination, a wedge-shaped hypoechoic area in Morison's pouch that is bounded on both sides by echogenic lines (the “FAST Double-Line Sign”) is likely to represent perinephric fat and may result in a false-positive FAST examination.     

Nonoperative management of delayed splenic rupture in an adult

Due to the evidence that a splenectomized patient is at increased risk for serious infection, nonoperative management of splenic injury, as well as operations designed to preserve functioning splenic tissue, have been recently reported. Most experience in nonoperative management has been in the pediatric and young-adult age groups. We report a case of delayed rupture of the spleen in a middle-aged patient who was successfully managed nonoperatively and was followed with ultrasonography to resolution.Supported in part by the Bureau of Medicine and Surgery Clinical Investigation Program.