Professional soccer player with an in-game ankle injury

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Professional player with an in-game ankle injury

Congenital bilateral absence of the semimembranosus muscles Abstract Variations of the anatomy of the hamstring muscle complex are uncommon. In particular, absence of some or all of the hamstring muscles is rarely described in the literature. This report presents a case of absent semimembranosus musculature detected incidentally on knee magnetic resonance imaging (MRI), then found to be bilateral on MRI of both thighs performed shortly thereafter. Imaging also demonstrated atypical morphologies of the semitendinosus and biceps femoris muscles in both thighs.

Dual steristrip technique: a novel use of steristrips to reduce operator radiation dose during CT-guided intervention Abstract Objective We describe a novel and safe needle-holding method that we have termed the ‘dual steristrip technique’. This technique can be used to stabilize the bone biopsy needle without the need for the radiologist’s hand to be in close proximity to the X-ray beam during CT-guided intervention. Materials and methods The dual steristrip technique uses steristrips to stabilize the bone biopsy needle and allows for accurate assessment of needle position and trajectory. This involves affixing one end of a steristrip to the skin 2 cm from the needle skin entry point, wrapping the mid-section of the steristrip around the biopsy needle and affixing the other end of the steristrip to the skin at the opposite side of the needle 2 cm from the needle skin entry point. A second steristrip is then applied in a similar fashion at 90° to the first steristrip. Results In our institution, we have used the dual steristrip technique to stabilize the biopsy needle in certain cases where assessment of needle position/trajectory can be more challenging. This includes cases where there is a paucity of soft tissues overlying the bone or if the bone lesion is located in the superficial cortex. We have found it to be successful in 80% of cases. Conclusions The dual steristrip technique is a safe and effective needle stabilization method that should be considered by the interventional radiologist in challenging CT-guided bone biopsy cases.

Myoepithelial carcinoma of tibia mimic giant cell tumor: a case report with emphasis on MR features Abstract Intraosseous myoepithelial carcinoma is an extremely rare type of bone tumor that most often presents in the long tubular bones, but also occurs in small tubular bones and the axial skeleton. We report the radiographic images and complete magnetic resonance (MR) features of a 44-year-old male with right knee pain of 7 months’ duration. The radiographic findings and convention MR images indicated a giant cell tumor of the bone. The dynamic contrast-enhanced images showed a patent with the early wash-in and early wash-out usually noted in a giant cell tumor of the bone. Only water restriction on diffusion-weighted imaging (DWI) showed the malignant impression. Care should be taken when conventional images indicate giant cell tumor of the bone, as intraosseous myoepithelial carcinoma, although rare, can mimic this more common diagnosis. Further studies with DWI are warranted.

The diagnostic accuracy of imaging modalities to detect pseudarthrosis after spinal fusion—a systematic review and meta-analysis of the literature Abstract Objective The aim of the study was to determine the diagnostic accuracy of imaging modalities to detect pseudarthrosis after thoracolumbar spinal fusion, with surgical exploration as reference standard. Materials and methods A systematic literature search for original studies was performed on the diagnostic accuracy of imaging as index test compared to surgical exploration as reference standard to diagnose pseudarthrosis after thoracolumbar spinal fusion. Diagnostic accuracy values were extracted and methodologic quality of studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Per modality, clinically comparable studies were included in subgroup meta-analysis and weighted odds ratios (ORs) were calculated using the random effects model. Results Fifteen studies were included. Risk of bias was classified as high/unclear in 58% of the studies. Concerns of applicability was classified as high/unclear in 40% of the studies. Four scintigraphy studies including 93 patients in total were pooled to OR = 2.91 (95% confidence interval [CI]: 0.93–9.13). Five studies on plain radiography with 398 patients in total were pooled into OR = 7.07 (95% CI: 2.97–16.86). Two studies evaluating flexion-extension radiography of 75 patients in total were pooled into OR = 4.00 (95% CI: 0.15–105.96). Two studies of 68 patients in total were pooled for CT and yielded OR = 17.02 (95% CI: 6.42–45.10). A single study reporting on polytomography, OR = 10.15 (95% CI 5.49–18.78), was also considered to be an accurate study. Conclusions With a pooled OR of 17.02, CT can be considered the most accurate imaging modality for the detection of pseudarthrosis after thoracolumbar spinal fusion from this review.

Small soft tissue masses indeterminate at imaging: histological diagnoses at a tertiary orthopedic oncology clinic Abstract Objective To review histologic diagnoses of soft-tissue masses (STMs) ≤ 2 cm with indeterminate imaging features encountered in musculoskeletal oncology clinic at a tertiary referral center. Materials and methods This was an IRB-approved retrospective review of patients with STMs ≤ 2 cm, referred to our tertiary care orthopedic oncology clinic over 4.75 consecutive years. Maximum diameter was based on imaging measurement by a fellowship-trained musculoskeletal radiologist. Simple lipomas, synovial cysts, metastases, and cases without histologic confirmation were excluded. Patient demographics, tumor imaging features (location, depth, size, and tumor:muscle enhancement and T2 signal ratios), and histology were recorded and compared. Results Mean maximum diameter for 42 trunk/extremity STMs was 1.5 cm (range, 0.7 to 2 cm). Mean age was 48 years (range, 18–83 years). Nine (21%) of the masses were malignant, while 33 (79%) were non-malignant. Thirty-nine (93%) of masses were superficial; 7/39 (18%) of these superficial tumors were malignant. Malignancy was not associated with underlying vessels, tendon, or fascia (p = 0.19). The non-malignant vs. malignant tumor:muscle enhancement ratio was 2.15 vs. 2.32 (p = 0.58) and enhancement coefficient of variation was 0.14 vs. 0.10 (p = 0.29). Most common malignant histologic subtypes were synovial sarcoma (n = 3), fibroblastic/myofibroblastic sarcoma (n = 2), leiomyosarcoma (n = 2), myxofibrosarcoma (n = 1), and angiomatoid fibrous histiocytoma (n = 1). The majority (67%) of non-malignant lesions were: leiomyoma (n = 6), angiomyoma (n = 5), schwannoma (n = 4), benign fibrous histiocytoma (n = 4), and hemangioma (n = 3). Conclusions At a tertiary musculoskeletal oncology referral clinic, primary STMs ≤ 2 cm with indeterminate imaging features should be managed cautiously despite their small size and/or superficial location.

Upper extremity myxofibrosarcoma mimicking an erosive inflammatory arthritis: a case report Abstract Myxofibrosarcoma is a malignant fibroblastic soft tissue neoplasm containing a variable amount of myxoid stroma that commonly presents as a slow-growing mass in elderly patients. The neoplasm may be superficial or deep to the muscle fascia and characteristically has an infiltrative growth pattern with a dominant or multinodular mass. We describe an unusual case of high-grade myxofibrosarcoma of the wrist and forearm that infiltrated the muscles, tendons, and wrist joint, causing bone erosions. The tumor was mistakenly diagnosed as synovitis and a chronic, erosive, inflammatory process. The diffuse nature, absence of a dominant mass, and radiographic appearance complicated the diagnosis. Although neoplasms of the synovial spaces are rare, this case demonstrates that tumors with a highly infiltrative growth pattern can mimic inflammatory synovitis and that neoplasms should be considered in the differential diagnosis when clinical and laboratory features are discordant with the imaging appearance.

Coracoid stress fracture in an elite fast bowler: description of a technique for CT-guided percutaneous screw fixation of coracoid fractures Abstract Coracoid stress fractures are a rare sports injury but present a management challenge, with the focus on optimising return-to-play, whilst minimising complications. Potential contributing mechanisms for the injury are briefly discussed and a novel approach to accurate fracture fixation under CT guidance is described. The ability of radiologists to orient themselves in 3D with a volume dataset on a workstation provides an image-guided option for percutaneous fixation that minimises risk of complications.