Biomedical subjects
Publications and source records attributed to G Y El-Khoury.
Most of the previously reported lumbosacral nerve root avulsions presented with pseudomeningoceles at the time of delayed initial imaging. We report a case of traumatic lumbosacral nerve root injury associated with an isolated femur fracture and demonstrate the evolution of pseudomeningoceles following nerve root avulsions and edema in the perineural fat identified on the initial MR imaging.
In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. Early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized.
OBJECTIVE: Our objectives were to report tendon abnormalities diagnosed on 3D volume-rendered images from MDCT data and to validate the clinical usefulness of this technique. CONCLUSION: We present 18 tendon abnormalities from 16 patients that were diagnosed on 3D volume-rendered MDCT images generated by commercially available software. Certain abnormalities such as avulsions, partial tears, and dislocations of tendons are clearly shown by this technique. This technique may prove useful in the evaluation of tendon abnormalities when MRI or sonography cannot be used.
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We describe two cases of focal fibrocartilaginous dysplasia, one treated conservatively while the other underwent curettage of the lesion. Resolution of tibia vara and healing of the focal fibrocartilaginous dysplasia was noted at 6 months in the patient who underwent curettage while the conservatively managed patient required 8 years of follow-up. Of the 17 cases of conservatively followed tibial focal fibrocartilaginous dysplasia described in the literature, 11 showed complete recovery after a median interval of 57 months. We believe that curettage may result in rapid healing by removing the persistent mesenchymal anlage which can interfere with the normal growth of the tibia.
OBJECTIVE: To report five symptomatic patients, four with unequivocal Paget's disease and large areas of osteolysis and one patient with presumed osteolytic Paget's disease, evaluated by MR imaging to confirm or exclude a sarcoma. DESIGN AND PATIENTS: Four men and one woman (median age 74 years) presented with new symptoms of pain. Four of these patients had unequivocal Paget's disease with large areas of osteolysis; one patient presented with large focal osteolysis and no other finding. MR imaging was performed in each case to exclude malignancy in the area of osteolysis. RESULTS: Two patients whose MR images showed a low signal abnormality on the T1-weighted sequence corresponding to osteolysis on the radiograph were found to have malignant degeneration. Three patients with osteolytic lesions on T1-weighted MR imaging showed preservation of fat signal in the areas of osteolysis, were not biopsied and have been free of malignant disease for from 12 months to 2 1/2 years. One patient had one area of osteolysis in the iliac bone which showed malignancy and another area of osteolysis which showed preservation of fat signal on the T1-weighted sequence. CONCLUSIONS: The information obtained from T1-weighted MR imaging sequences performed on patients with Paget's disease who have new symptoms and large areas of osteolysis could reliably be used in the clinical decision-making process between conservative follow-up and biopsy.
OBJECTIVE: To present and discuss six cases of calcific tendinitis in atypical locations (one at the insertion of the pectoralis major and five at the insertion of the gluteus maximus). PATIENTS AND RESULTS: All cases were associated with cortical erosions, and five had soft tissue calcifications. The initial presentation was confusing and the patients were suspected of having infection or neoplastic disease. CONCLUSION: Calcific tendinitis is a self-limiting condition. It is important to recognize the imaging features of this condition to avoid unnecessary investigation and surgery.
OBJECTIVE: We wanted to determine whether the standard three-view ankle radiographic series could be replaced by a two-view combination, and if so, which two-view combination (anteroposterior with lateral or mortise with lateral) would be superior. MATERIALS AND METHODS: During a 12-month period, we retrospectively reviewed 556 consecutive ankle radiographic studies consisting of anteroposterior, mortise, and lateral views. One hundred twenty patients with at least one ankle fracture were paired with 140 healthy control subjects. Each image in the three-view examination was separated and sorted by view and studied independently; all images were reviewed by two skeletal radiologists and two orthopedic surgeons. Each radiograph was evaluated for fracture of the medial, lateral, and posterior malleoli and the foot using a five-point confidence rating. Performance of each view and modeled two- and three-view combinations of views was evaluated with modified receiver operating characteristic analysis. RESULTS: The data provide little support for preferring either two-view combination (anteroposterior-lateral or mortise-lateral) for any type of fracture. The three-view combination does detect significantly more fractures than some two-view combinations in some locations, and there is a statistically significant cost in diagnostic accuracy for eliminating the anteroposterior or mortise view. CONCLUSION: Reducing the ankle radiographic series from three to two views would result in a small but significant decrease in the detection of fractures of the ankle and foot. Both two-view combinations are equivalent for fracture detection.
Subchondral metastasis is a rare occurrence and poses a diagnostic dilemma as initial films may show a lytic lesion in the subchondral region often misinterpreted as being benign. We present five cases of subchondral metastasis as well as a review of the literature. In our cases, we present subchondral metastasis in the elbow, shoulder, and hip joints. All patients had pain over the affected joint and most presented with a lytic lesion in the subchondral bone. Three patients have died since presentation and two are doing well at last follow up visit. Subchondral metastasis is a rare entity, but it should be included in the differential of a lytic lesion in the subchondral bone.
A case of paraarticular soft-tissue osteoma of the hip is presented. The patient is a 30-year-old white male with a two year history of progressive left hip pain. Plain film and cross-sectional imaging in conjunction with pathologic correlation are used to make the diagnosis. The lesion lacks the typical zoning pattern of myositis ossificans, shows no direct communication with native bone, and is extraarticular in location as opposed to synovial osteochondromatosis. Soft tissue osteomas most commonly occur around the knee, the foot, and the ankle. Soft tissue osteomas are rare tumors and this case is unusual in that it occurs around the hip.
OBJECTIVE: We wanted to determine the prevalence and appearance of elastofibroma dorsi in an elderly patient population (n = 258) who underwent CT of the chest for reasons other than to evaluate posterolateral chest wall pain, stiffness, or a mass. CONCLUSION: Five elastofibromas were detected in four patients; none of these elastofibromas were noted at initial examination. Our study suggests that the prevalence of elastofibroma dorsi revealed by CT is 2%, which is lower than the 11-24% found in autopsy series but higher than expected for such a rare tumor. Elastofibroma dorsi typically has a layered appearance on CT; however, in our study, homogeneous soft-tissue attenuation was noted. The diagnosis is often missed prospectively. Familiarity with the location and imaging appearance of elastofibroma dorsi may enhance detection and characterization of posterolateral chest wall masses in elderly patients.
A modified technique was used for diagnostic aspiration of fluid from the hip in 185 patients who had previously undergone total hip arthroplasty. The aspiration needle was advanced past the lateral aspect of the shaft of the prosthesis and into the dependent portion of the joint. Fluid was successfully aspirated in 181 of 185 patients; thus the dry-tap rate was 2.2% (four of 185 patients). The modified technique was simple, could be performed quickly, and was effective for sampling joint fluid in patients with hip prostheses.
Although skeletal muscle is the single largest tissue in the body, there is little written about it in the radiologic literature. Indirect muscle injuries, also called strains or tears, are common in athletics, and knowing the morphology and physiology of the muscle-tendon unit is the key to the understanding of these injuries. Eccentric muscle activation produces more tension within the muscle than when it is activated concentrically, making it more susceptible to tearing. Injuries involving the muscle belly tend to occur near the myotendinous junction. In adolescents, the weakest link in the muscle-tendon-bone complex is the apophysis. Traditionally, plain radiography has been the main diagnostic modality for evaluation of these injuries; however, with the advent of MRI it has become much easier to diagnose injuries primarily affecting the soft tissues. This article reviews the anatomy and physiology of the muscle-tendon unit as they relate to indirect muscle injuries. Examples of common muscle injuries are illustrated.
Rupture of the pectoralis major muscle is a rare clinical entity. Only few reports have discussed its MRI or CT features. We have reviewed the imaging features of four cases of complete rupture of the pectoralis major muscle. One case of acute injury underwent surgical repair. MRI is useful in delineating the site and extent of the rupture in relation to the musculotendinous junction, which will help the surgeons with possible treatment options and surgical planning. Because of the complex anatomy of the pectoralis major muscle near its insertion on the humerus and the signal characteristics of hematoma and edema in the muscle, axial T2-weighted images were most valuable for the evaluation of acute and subacute injuries. Axial T1-weighted images were helpful in delineating chronic injuries. CT is inferior to MRI for direct visualization of muscle rupture.
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The seronegative spondylarthropathies are a group of multisystem inflammatory disorders that share a variety of clinical, radiologic, and genetic features. They include ankylosing spondylitis, psoriatic arthritis, Reiter's disease, and arthritis associated with inflammatory bowel disease. This article reviews these multisystem inflammatory disorders.
Three Down syndrome patients with posterior atlantooccipital (AO) subluxation are described. All are asymptomatic. The subluxation becomes manifest during active extension of the neck and reduces in flexion. Methods of assessing posterior AO subluxation are discussed. The abnormality is attributed to ligamentous laxity in patients with Down syndrome.
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