Imaging the ligaments of the trapeziometacarpal joint: MRI compared with MR arthrography in cadaveric specimens.

OBJECTIVE: The purpose of our study was to compare the normal ligamentous anatomy of the trapeziometacarpal joint in cadavers on conventional MRI and MR arthrography and review the most common diseases and abnormalities that affect this articulation. MATERIALS AND METHODS: MR images of seven trapeziometacarpal joints of seven fresh cadaveric hands were obtained before and after arthrography. The MR appearances of the ligaments around the trapeziometacarpal joint were analyzed and correlated with corresponding anatomic sections. The imaging planes that allowed best analysis of these structures were determined. RESULTS: Five ligaments around the trapeziometacarpal joint were generally recognized: the dorsoradial ligament; the posterior oblique ligament; the intermetacarpal ligament; the ulnar collateral ligament (UCL); and both portions of the anterior oblique ligament, the superficial anterior oblique and deep anterior oblique ligaments. The former three were attached to the dorsal aspect and the latter three to the volar aspect of the trapeziometacarpal joint. The dorsoradial ligament, posterior oblique ligament, intermetacarpal ligament, and superficial and deep anterior oblique ligaments were best visualized in the sagittal plane, whereas the UCL was best visualized in the coronal plane. MR arthrography mainly improved visualization of the intermetacarpal ligament, superficial and deep anterior oblique ligaments, and UCL. CONCLUSION: MR arthrography improves visualization of and provides detailed information about the anatomy of the ligaments around the trapeziometacarpal joint. Knowledge of the appearance of these normal ligaments on MRI allows accurate diagnosis of lesions of the trapeziometacarpal ligaments and of the adjacent structures and aid the attending physician if and when surgery is indicated.

Intersection syndrome: MR imaging with anatomic comparison of the distal forearm.

OBJECTIVE: To correlate the anatomic and MR imaging characteristics of the area of intersection of the first and the second dorsal extensor tendon compartments (DETC) in the distal forearm in an attempt to improve the design of MR imaging protocols used for the evaluation of intersection syndrome. DESIGN AND PATIENTS: Ten forearms of nine cadavers underwent MR imaging in the axial and sagittal-oblique planes before and after tenography with direct injection of a gadolinium-containing contrast agent into the first DETC in four forearms, the second DETC in four forearms, and both compartments in the remaining two forearms. The area of intersection between the first and second DETC was identified in each case as well as its distance from Lister's tubercle. Subsequently all forearms were sectioned in the axial (8 forearms) or sagittal-oblique planes (2 remaining forearms) to parallel the imaging planes. Detailed examination of each of the anatomic slices was performed in a search for anatomic variations and for possible anatomic connections of the tendons sheaths. One forearm was dissected to identify the area of intersection. RESULTS: The area of intersection between the first and second DETC occurred between 3.5 cm and 4.8 cm (mean 4.18 cm) proximal to Lister's tubercle. After tenography, gadolinium solution was noted in the third DETC in two of four specimens in which the second DETC was injected and in one of two specimens in which both the first and second DETC were injected. Extension of the gadolinium solution between the first and second DETC was noted during isolated injections of either compartment, although this finding may have related to iatrogenic injection effects. The axial plane was the most valuable for assessment of the area of intersection of the first and second DETC. CONCLUSION: MR imaging is a noninvasive method that can be used for the evaluation of distal forearm and wrist pain. Standard wrist protocols do not include the area of intersection between the first and second DETC and, in those cases in which intersection syndrome is suspected, the MR examination must be tailored to include the forearm.

Sarcoma sinovial fibrose do pé: relato de caso / Fibrous synovial sarcoma of the foot: a case report

Os autores relatam o caso de uma paciente de 24 anos de idade, que apresentou dor e aumento do volume do hálux esquerdo há três meses. A ultra-sonografia mostrou massa sólida, hipoecóide, heterogênea, com áreas císticas e calcificação, no dorso do hálux esquerdo, em partes moles, com estrutura tendínea no seu interior, sem aparente comprometimento de estruturas ósseas. O estudo com Doppler colorido mostrou hipervascularização central e periférica na lesão. A ressonância magnética evidenciou massa sólida, de partes moles, com estrutura tendínea no seu interior, com médio sinal em T1 e alto sinal em T2, com realce intenso e heterogêneo pelo meio de contraste paramagnético, sem acometimento de estruturas ósseas. A paciente foi submetida a procedimento cirúrgico, com ressecção da lesão descrita, no dorso do hálux esquerdo, e o exame anatomopatológico demonstrou tratar-se de sarcoma sinovial fibroso monofásico.

Torção hepática e obstrução de cólon transverso: relato de um caso e revisão da literatura / Hepatic torsion with colonic obstruction: a case report and review of the literature

Os autores relatam o caso de uma paciente de 20 anos de idade, sem antecedentes patológicos, que apresentou quadro de abdome agudo obstrutivo. Realizou exames radiológicos, ultra-som e tomografia computadorizada, seguidos de laparotomia explorada, sendo constatadas: a) rotação hepática completa para o hipocôndrio esquerdo; b) hipotensão severa por compressão da veia cava inferior; c) malformação congênita dos ligamentos falciforme e coronários; d) obstrução do cólon transverso por bridas constritivas congênitas; e) importante distensão gasosa de alças cólicas no hipocôndrio direito. Foram ressecadas as bandas pericólicas, com redução imediata da dilatação no hemiabdome direito, havendo retorno espontâneo do fígado à posição anatômica. Esta condiçãoímpar, o os outros três casos similares já descritos na literatura mundial, são comentados neste trabalho.

Síndrome de Peutz-Jeghers e intussuscepçäo: relato de um caso e revisäo da literatura

Resumo: Os autores relatam um caso de uma mulher, de 28 anos de idade, com intussuscepçäo ileocecocólica associada à síndrome de Peutz-Jeghers, uma doença autossômica dominante caracterizada por pópolis harmartomatosos no trato gastrointestinal e pigmentaçäo mucocutânea. Esta patologia apresenta complicaçäo frequêntes, tais como obstruçäo intestinal por intussuscepçäo e hemorragia. No caso aqui apresentado, o diagnóstico da invaginaçäo foi pré-operaatório, por meio de exames de imagem. A paciente foi submetida a laparotomia, durante a qual foi realizada hemicolectomia direta. Na peça cirúrgica foram encontrados três pólipos de grandes dimensöes, interpretados como sendo a causa da intussuscepçäo