Application value of imaging examination in the diagnosis of Muller-Weiss disease / 中国骨伤

OBJECTIVE@#To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.@*METHODS@#The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.@*RESULTS@#Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.@*CONCLUSION@#Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.

No dejemos morir al hueso: interiorizándonos con los procesos óseos avasculares / Do not let the Bone Die: Interiorizing with the avascular Bone Processes

Resumen El objetivo de este artículo es realizar una revisión de las localizaciones, causas y hallazgos radiológicos específicos de los procesos avasculares óseos. Se define como isquemia ósea a las alteraciones ocasionadas por déficit de irrigación, llevando a la destrucción del hueso. Existen diferencias entre necrosis isquémica e infarto óseo, en base al sitio óseo de afectación. La etiología traumática es la más frecuente y suele ser unilateral. Los sitios de presentación más frecuentes son: cabeza femoral y humeral, rodilla y semilunar. La resonancia magnética (RM) es considerada la modalidad de imagen más sensible y específica, tanto para el diagnóstico temprano como estadificación y control. El conocimiento de las causas, características radiológicas y sus diferentes fases evitan el diagnóstico erróneo de otras etiologías, como las primarias o infecciosas, facilitando un correcto algoritmo terapéutico.

Abstract The aim of this article is to review the locations, causes and specific radiological findings of avascular bone processes. Bone ischemia is defined as the alterations caused by irrigation deficit, leading into the bone destruction. However, there are differences between ischemic necrosis and bone infarction, based on the bone site of involvement. The most frequent etiology is traumatic and is usually unilateral. The most frequent sites of presentation are: femoral and humeral head, knee, and lunate. Magnetic resonance imaging (MRI) is considered the most sensitive and specific imaging modality for early diagnosis, staging and control. The knowledge of the causes, radiological findings and their different phases avoid the erroneous diagnosis of other lesions, such as primary or infectious, facilitating a correct therapeutic algorithm.

Sincondrose Dolorosa da Patela ­ uma causa incomum de dor no joelho / Patellar painful Synchondrosis ­ An uncommon cause of knee pain

A patela é o maior osso sesamoide do corpo humano, posicionado longitudinalmente na fáscia do músculo quadríceps, entre os tendões quadríceps e patelar. A patela bipartida dolorosa, também conhecida como "sincrondose dolorosa", é uma causa conhecida de dor no joelho anterior, é um diagnóstico de exclusão. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital Luxemburgo, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 45 anos com dor no joelho direito há 01 ano, principalmente na região anterior, que piora ao agachar. Ao exame físico apresenta edema com dor a palpação da patela. A radiografia demonstra patela bipartida. A ressonância magnética (RM) do joelho direito demonstra patela bipartida com união fibrosa entre o fragmento bipartido superolateral e a patela, associada a lesões condrais e edema subcondrais, compatível com "sincondrose dolorosa" da patela. Conclusão: Este relato demonstra a dificuldade de diagnosticar está lesão, pois seu o exame físico é inespecífico e a radiografia demonstra apenas a variação da normalidade ­ patela bipartida, sem evidenciar as alterações próprias da doença, caracterizada apenas pela RM.

The patella is the largest sesamoid bone in thehuman body, positioned longitudinally in the quadriceps muscle fascia, between the quadriceps and patellar tendons. The painful bipartite patella, also known as "painful synchondrosis", is a known cause of anterior knee pain, is a diagnosis of exclusion.Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital Luxemburgo, a photographic record of diagnostic methods, and a review from the literature. Results: 45-year-old man with right knee pain for 1 year, mainly in the anterior region, which worsens when crouching. Physical examination shows edema with pain on palpation of the patella. Right knee radiography demonstrates a bipartite patella. Magnetic resonance imaging (MRI) of the right knee demonstrates a bipartite patella with a fibrous union between the superolateral bipartite fragment and the patella, associated with chondral lesions and subchondral edema, compatible with patella "painful synchondrosis". Conclusion: This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is nonspecific and the radiography shows only the normal variation ­ bipartite patella, without evidencing the disease alterations, characterized only by MRI.

Histiocitosis de células de Langerhans con compromiso esternal aislado: Caso clínico / Langerhans cell histiocytosis with isolated sternum involvement: A clinical case

La histiocitosis de células de Langerhans es una entidad poco frecuente, que se caracteriza por la proliferación clonal de células dendríticas con amplia variabilidad clínica. En algunos casos, la enfermedad tiene afectación multisistémica con compromiso de vida y, en otros casos, de compromiso exclusivamente óseo, en los que la sobrevida es del 100%. Se presenta a una niña de 8 años que consultó al Servicio de Urgencias por dolor esternal de 4 días de evolución. Mediante estudios de imágenes, se observó una imagen lítica en el esternón. Se decidió la internación para el manejo del dolor y estudio. Se realizó una punción-aspiración con aguja fina, cuya inmunohistoquímica fue positiva para el marcador CD1a, que confirmó el diagnóstico de histiocitosis. La paciente recibió 40 mg/día de metilprednisolona, con buena evolución. Se decide exponer este caso por ser una forma de presentación atípica de una enfermedad poco prevalente, pero cuyo motivo de consulta amerita la sospecha diagnóstica.

The Langerhans Cell Histiocytosis (LCH) is a rare condition, characterized by the proliferation of dendritic cells. Its clinical presentation is variable and ranges from an isolated skin or bone disease, mainly the skull, to a life-threatening multisystemic disease. This case is about a healthy 8-year-old girl with a history of four days of severe sternum pain and no other symptomatology. At the initial evaluation at the emergency department a chest X-ray (Figure 1) and thoracic computed tomography scan with 3-D reconstruction were performed and they showed the sternal osteolytic lesion (Figure 2). She was admitted to the hospital for further evaluation. The immunohistochemistry evaluation of the fine needle aspiration sample was positive for CD1a, confirming the diagnosis of histiocytosis. The patient received methylprednisolone 40 mg/day with clinical improvement.

Langerhans' cell histiocytosis with neurological injuries diagnosed from a single cutaneous lesion

Abstract: Histiocytoses are rare diseases caused by the proliferation of histiocytes. The pathogenesis remains unknown and the highest incidence occurs in pediatric patients. The clinical presentations can be varied, in multiple organs and systems, and the skin lesions are not always present. Evolution is unpredictable and treatment depends on the extent and severity of the disease. It is described the case of a patient with various neurological symptoms, extensively investigated, who had its was diagnosed with histiocytosis from a single skin lesion. This report highlights the importance of Dermatology in assisting the investigation of difficult cases in medical practice.

Positive or Negative Ulnar Variance after Ulnar Shortening for Ulnar Impaction Syndrome: A Retrospective Study

BACKGROUND: The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. METHODS: Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. RESULTS: A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. CONCLUSIONS: After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.

Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy

To determine the impact of three-phase bone scintigraphy [TPBS] on the diagnosis and management of complex regional pain syndrome type I [CRPSI] or reflex sympathetic dystrophy [RSD]. Twenty consecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

Technetium-99m MDP bone scintigraphic findings of hypercalcemia in accelerated phase of chronic myelogenous leukemia

Hypercalcemia in accelerated phase of chronic myelogenous leukemia (CML) is very rare. Its pathogenesis is considered humoral hypercalcemia of malignancies mediated by parathyroid hormone-related protein (PTHrP). In severe hypercalcemia, calcifications in kidneys, skin, vessels, heart, and stomach may occur. Our two cases were admitted because of severe hypercalcemia in accelerated phase of CML. On Tc-99m methylene diphosphonate (MDP) bone scintigraphies, a marked tracer accumulation was seen in the lung, heart, stomach and kidney. We report increased tracer accumulation of multiple organs on Tc-99m MDP bone scintigraphy in two rare hypercalcemic patients with CML.