role of wrist magnetic resonance arthrography in diagnosing triangular fibrocartilage complex tears. Experience at King Hussein Medical Center, Jordan

The aims of the study were to evaluate the role of magnetic resonance arthrography [MRA] of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex [TFCC] and to compare the results of the magnetic resonance arthrography [MRA] with the gold standard arthroscopic findings. The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients [35 males and 7 females] who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography [MRA] and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. After comparison with the arthroscopic findings, the MRA had three false-negative results [sensitivity = 93%] and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% [39], and specificity was 80% [16/20]. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% [29/34]. These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries

Mediastinal foregut duplication cyst

We report an uncommon case of mediastinal esophageal foregut duplication cyst in a child. Our case is a 9-year-old male who presented to the outpatient clinic at Princess Haya Hospital with a history of cough and fever. Chest X-ray showed an incidental finding of a silent mediastinal mass. It was completely excised and was proved to be an esophageal foregut duplication cyst

Macrodystrophia lipomatosa

Macrodystrophia lipomatosa is a congenital form of localized gigantism characterized by an increase in all mesenchymal elements particularly fibroadipose tissue. We describe two patients with Macrodystrophia lypomatosa affecting the hand, which exhibited characteristic radiological and MRI findings that distinguish the lesion from other conditions associated with localized gigantism

role of MRI in the diagnosis of Morton neuroma

The main aim of this study was to evaluate the role of MRI in patients suspected of having Morton neuroma [intermetatarsal neuroma], and to assess the importance of the various MRI sequences in this disease. Patients and thirty patients with a clinical suspicion of Morton neuroma were examined with a 1.0 Tesla MRI scanner. T1W axial, T2W axial, fat suppression, and T1W post contrast images were obtained. Sixteen of the 30 patients underwent surgery subsequently. twelve patients of the 16 had Morton neuroma proven. There were 11 true positive, 1 false negative, 4 true negative, and no false positive diagnoses based on MRI. Of the 12 proven Morton neuroma cases, there were 5 cases in which the clinician was unable to localize the exact intermetatarsal space. In the 14 patients who did not undergo surgery the MRI results were as follows: 4 Morton neuroma, 1 stress fracture, 2 non-specific fibrosis, and 7 no abnormality. MRI is accurate in the diagnosis and localization of Morton neuroma. T1W images are the most important sequence. T2W images are included to define cystic lesions and bursae. STIR images are of some value. Post Gad T1W images were excluded from the routine sequences and reserved for when other pathology is suspected

role of MRI in diagnosis of Morton neuroma

The main aim of this work is to evaluate the role of MRI in patients suspected to have Morton Neuroma [Intermetatarsal Neuroma] and to assess the importance of the various MRI sequences in this disease. 30 Patients with a clinical suspicion of Morton Neuroma were examined with a 1.0 Tesla MRI scanner. T1W axial, T2W axial, fat suppression and T1W post contrast images were obtained. 16 patients out of 30 underwent surgery. Twelve patients out of 16, Morton Neuroma was proven surgically. 11 true positive, 1 false negative, 4 true negative and no false-positive MRI diagnosis were given. 5 of 12 proven Morton Neuroma, the clinician was unable to localize the exact intermetatarsal space. The MR results of the 14 remaining patients who did not undergo surgery were Morton Neuroma [n=4], stress fracture [n=1], non-specific fibrosis [n=2], and no abnormality [n=7].MRI is accurate in diagnosis and localization of Morton Neuroma. TIW images is the most important sequence, T2W images is included to define cystic lesions and bursa. STIR images are of some value while post Gad TIW images was excluded from the routine sequences and reserved for when other pathology is suspected

Macrodystrophia lipomatosa

Macrodystrophia Lipomatosa is a congenital form of localized gigantism characterized by an increase in all mesenchymal elements particularly fibroadipose tissue. We describe two patients with Macrodystrophia Lipomatosa affecting the hand that exhibited characteristic radiological and MRI findings that distinguish the lesion from other conditions associated with localized gigantism

Sentinel node in management of malignant melanoma

One of the most important prognostic features of malignant melanoma is the involvement of regional lymph nodes. The aim of this study is to identify the sentinel lymph node which is the first node to be involved by metastases from malignant melanoma and then decide which patients can benefit from lymph node dissection and which will only need clinical follow-up. Forty-four patients were included in this study from October 2000 to November 2001. The study was carried out at the St. Bartholomew's and Royal Hospital, London, United Kingdom. We undertook a pilot study of patients with malignant melanoma involving the outline technique. A consent form for all patients was taken. The only criteria for inclusion in this study was the Berslow thickness of the tumor which had to be over 2 mm. There were 18 females and 26 males, mean age of 57 years. The primary tumor site varied: upper limbs 14, lower limbs 10, trunk 18, and head and neck 2. Excision of one to 3 sentinel nodes [mean 1.4] was performed. The number of sentinel nodes was removed: one in 24 patients, 2 in 12, 3 in 6, and 4 in 2 patients. In 8/44 patients metastatic disease was detected in the sentinel node. Three patients had therapeutic lymph node dissection. There was no major complication. Four patients with one positive node each [evidence of micrometastases] have gone for lymph node dissection; one of them had one further positive node. Sentinel lymph node biopsy is increasingly used to stage melanoma in order to avoid lymph node dissection in patients who clinically have no lymph node involvement. Sentinel lymph node biopsy is a valuable technique for melanoma staging; however, impact on overall survival requires longer follow-up