Tumor de células gigantes de la bursa de la pata de ganso (bursitis villonodular pigmentada extraarticular): a propósito de un caso / Giant cell tumor of the pes anserine bursa (extraarticular pigmented villonodular bursitis): a case report

Resumen: La sinovitis villonodular pigmentada extraarticular, también llamada tumor de células gigantes de la vaina tendinosa, es frecuente en la mano, siendo extremadamente rara su localización en la rodilla. Se presenta el caso de un paciente con una bursitis villonodular pigmentada de la bursa de la pata de ganso sin afectación intraarticular. Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon sheath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Abstract: Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon seath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Concordancia diagnóstica de capsulitis adhesiva por resonancia magnética entre centros de imagenología y una clínica de reconstrucción articular con correlación quirúrgica / Diagnostic concordance of Magnetic Resonance Imaging of Adhesive Capsulitis, between Imaging Centers and a Shoulder Clinic, with surgical correlation

Resumen: Introducción: Los hallazgos en resonancia magnética (IRM) presentan una adecuada sensibilidad y especificidad para el diagnóstico de capsulitis adhesiva; sin embargo, existe una baja correlación diagnóstica entre la interpretación realizada en los centros de imagenología y la de la clínica de reconstrucción articular y los hallazgos quirúrgicos. Objetivo: Conocer la correlación del diagnóstico de capsulitis adhesiva por IRM entre centros de imagenología y la clínica de reconstrucción articular con posterior comprobación quirúrgica. Material y métodos: Estudio retrospectivo, observacional y comparativo en un grupo de 41 pacientes con diagnóstico de capsulitis adhesiva, comparando la concordancia de los reportes de IRM de distintos centros de imagenología y la clínica de reconstrucción articular, se corroboró quirúrgicamente en 10 casos. Se determinó el índice κ entre ambas interpretaciones y los hallazgos quirúrgicos. Resultados: La concordancia de los reportes analizados por el cirujano de hombro de la clínica de reconstrucción articular y los reportes de los centros de imagenología fue baja con un índice κ de 0.12, en todos los casos quirúrgicos se corroboró la presencia de capsulitis adhesiva, el índice κ con los reportes de los centros de imagenología fue de 0.10. Conclusión: Los hallazgos en la IRM descritos en la literatura son confiables para el diagnóstico capsulitis adhesiva. La baja concordancia con los centros de imagenología nos orienta a pensar que es una entidad subdiagnosticada por esas instituciones.

Abstract: Introduction: Despite the MRI findings present an adequate sensitivity and specificity for the diagnosis of adhesive capsulitis, there is a poor correlation between the imaging results in imaging centers and the diagnosis of a shoulder surgeon and the surgical findings. Objective: To evaluate the correlation of the diagnosis of adhesive capsulitis by MRI between imaging centers and the shoulder and elbow surgery service, with subsequent surgical verification. Material and methods: Retrospective, observational and comparative study in 41 patients with adhesive capsulitis diagnosis, the concordance among the MRI reports of different radiology cabinets and the Joint reconstruction clinic was calculated, in 10 cases the diagnosis was corroborated by surgery. The κ index was determinated between both interpretations and the surgical findings. Results: The concordance among the reports analyzed by the shoulder surgeon of the Joint reconstruction clinic and the cabinets was low, with a κ index of 0.12, in all the surgical cases the presence of adhesive capsulitis was proved with a κ index of 0.10 with respect to the cabinets reports. Conclusion: The imaging findings described in the literature are reliable for the diagnosis of adhesive capsulitis. The low concordance with the imaging cabinets leads us to think that it is an underdiagnosed entity.

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.

Evaluation of Shoulder Disorders by 2-F-18-fluoro-2-deoxy-D-glucose Positron Emission Tomography and Computed Tomography

BACKGROUND: Although flourine-18-flourodeoxyglucose (FDG) positron emission tomography (PET) has a limitation for localizing anatomical structures, combining it with computed tomography (CT) has made it more efficient for overcoming such limitations. This study aims to evaluate the efficacy of PET/CT for evaluating diseases of the shoulder. METHODS: Retrospective examination was performed on 25 patients who underwent FDG-PET/CT scanning. All the patients were over 60 years of age, and they were evaluated both clinically and radiologically for shoulder pain. The study period was from May, 2006 to May, 2008. One of the patients had metastatic lesion in a shoulder and this patient was excluded from the study, so the total number of subjects in the study was finally 24 patients. RESULTS: PET/CT showed 67% sensitivity, 73% specificity, a positive predictive value of 60%, a negative predictive value of 79%, 27% false positivity and 33% false negativity concerning shoulder pain. PET/CT showed negative finding in 4 cases that were successfully treated by operative treatment (rotator cuff tear [RCT], 3 cases; impingement syndrome, 1 case). Negative findings were also noted in 6 cases in which the pain subsided after conservative treatment (RCT, 1 case; suspected RCT, 2 cases; impingement syndrome, 3 cases). All the patients with osteoarthritis and rheumatoid arthritis had positive findings on PET/CT scanning. CONCLUSIONS: PET/CT is a useful adjunct to the existing imaging modalities to assess functional and pathophysiologic processes and at a very early stage, and so PET/CT can help physicians make better preoperative and postoperative decisions on treatment.

Correlation between Ultrasonographic Findings and The Response to Corticosteroid Injection in Pes Anserinus Tendinobursitis Syndrome in Knee Osteoarthritis Patients

The objectives of this study were to assess the ultrasonographic (US) findings in patients with knee osteoarthritis (OA) with pes anserinus tendinitis or bursitis (PATB) syndrome and to determine the correlation between the US findings and the response to local corticosteroid injection. We prospectively studied 26 patients with knee OA with clinically diagnosed PATB syndrome. A linear array 7 MHz transducer was used for US examination of the knee. Seventeen patients were injected locally with tramcinolone acetonide in the anserine bursa area. Response to local corticosteroid injection was evaluated by pain visual analog scale (VAS), Western Ontario and MacMaster (WOMAC) osteoarthritis index and Global patient/physician assessment using Likert scale. On US examination, only 2 patients (8.7%) showed evidence of PATB. Pain VAS, WOMAC pain index and WOMAC physical function index improved significantly after corticosteroid injection. Global patient assessment revealed that 2 patients showed best response, 6 good, 1 fair, 8 the same, and none worse. It is of note that the 2 patients who showed the best response were those who showed US evidence of PATB. This finding shows that US can serve as a useful diagnostic tool for guiding treatment in PATB syndrome of OA patients.

MRI of the shoulder joint

The aim of this work was to study the superior level of MRI and MR arthrography for the evaluation of the shoulder joint diseases. Sixty-five patients of different ages, occupations and different complaints and clinical suspicions were included in this study, 42 were subjected to plain MRI and 38 to MR arthrography and 15 were subjected to the two examinations. It was concluded that MRI with or without arthrography was the most available imaging modality for shoulder joint disease