Isolated pelvic fluid in males on outpatient magnetic resonance imaging examinations: differences in incidence based on age.

PURPOSE: Determine the incidence and amount of isolated pelvic fluid in males, stratified by age, on outpatient pelvic magnetic resonance imaging (MRI) examinations performed for lower back or extremity pain. METHODS: After institutional review board approval, 161 pelvic MRIs performed on males for musculoskeletal or neurologic indications over an 18-month period were retrospectively reviewed for isolated pelvic fluid by 2 radiologists. Patients with a potential etiology for the fluid were excluded. Volume and maximal 2-dimensional measurements of fluid were calculated. Statistical analysis included logistic regression, Wilcoxon rank-sum, and χ tests. RESULTS: Twenty (44.4%) of 45 patients 5 to 29 years old, 5 (10%) of 50 patients 30 to 49 years old, and 4 (6.1%) of 66 patients older than 50 years had isolated pelvic fluid (P < 0.001). Mean volume of fluid was 2.5 mL; 97% (28/29) had less than 10 mL. Mean maximal 2-dimensional measurement was 2.1 cm; 93% (27/29) had less than 6 cm(2). CONCLUSIONS: Isolated fluid is greater than 7 times more common on outpatient pelvic MRIs in males younger than 30 years compared with men older than 49 years. Fluid rarely exceeded 10 mL or 6 cm(2).

The cartilage black line sign: an unexpected MRI appearance of deep cartilage fissuring in three patients.

Many patterns of cartilage signal anomalies have been described in the knee since the advent of magnetic resonance imaging (MRI). With the now widespread use of preoperative MRI, some of these anomalies have proven to represent true pathology, while others have been shown to be normal variants or artifacts at arthroscopy. We describe three patients with an MR cartilage abnormality, not previously illustrated in the literature, consisting of a thin dark signal line on T2-weighted imaging, oriented perpendicular to the plane of imaging. This aberration proved to represent a deep cartilage cleft at arthroscopy (two patients) and at CT arthrography (one patient). Such full thickness fissures are generally considered to have the opposite appearance, that of fluid signal intensity on T2-weighted images.

Abdominal wall hernia mesh repair: sonography of mesh and common complications.

OBJECTIVE: The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS: We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS: A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS: Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.

Conventional and diffusion-weighted MRI findings of methotrexate related sub-acute neurotoxicity.

We describe longitudinal diffusion-weighted MRI findings of sub-acute leukoencephalopathy following methotrexate therapy in a 24-year-old man diagnosed with pre-B-cell acute lymphoblastic leukemia (ALL), presenting with right-sided paralysis and aphasia after second consolidation with intrathecal triple-drug therapy given intrathecally. This case demonstrates the value of DWI in evaluation and diagnosis of sub-acute toxic leukoencephalopathy in patients being treated with methotrexate. The longitudinal follow up DWI findings suggest reversible metabolic derangement rather than ischemia as the cause of these findings.

Arthroscopic meniscal repair: analysis of treatment failures.

The rationale for meniscal repair is based on the importance of the meniscus in overall knee function and stability as well as the inferior results seen with meniscectomy. The high success rate usually seen with arthroscopic meniscal repair has made it the treatment of choice for peripheral meniscal tears. This study reviewed the records of patients who have failed meniscal repair surgery to gain greater understanding of the factors that may predispose a patient to a failed outcome. From 1987 to 2002, three hundred meniscal repairs were performed (203 medial and 97 lateral). Thirty-seven patients had failed meniscal repairs. Records were available for 33 (89%) patients. The mean patient age was 25 years (range: 13-48 years) at the time of meniscal injury. The average initial tear size was 2.7 cm with a mean rim width of 2.3 mm. Eighty-eight percent occurred in ACL tears. The average time interval from initial repair to the recurrence of symptoms was 34 months. Patients who were older at the time of meniscal repair failed significantly later than those patients who were younger at the time of repair. With age stratification, those patients who were aged > or =29 years at time of meniscal repair failed at an average of 23 months. In contrast, patients who were aged > or =30 years at the time of repair failed at an average of 53 months. Larger initial tears failed significantly sooner than smaller tears. Initial tears with larger rim widths demonstrated a trend toward shorter time to failure. Patients who underwent combined ligament reconstruction with meniscal repair failed at an average of 37 months. Deficient ACLs that were treated with isolated meniscal repairs (ACL intact) failed at an average of 16 months.

Postoperative pain management after anterior cruciate ligament reconstruction.

This study compared pain and its management in four groups of patients after anterior cruciate ligament (ACL) surgery. Group 1 consisted of primary ACL reconstruction, group 2 primary ACL reconstruction with meniscal repair, group 3 primary ACL reconstruction with meniscal resection, and group 4 revision ACL reconstruction with patellar tendon allograft. Each patient was instructed to record his or her pain level on a visual analog pain scale (VAS) prior to the procedure and for 7 days postoperatively. All patients received a prescribed narcotic to be taken orally as needed every 4-6 hours. Each patient was instructed to taper its use and supplement with non-narcotic as symptoms allowed. The VAS score for all groups peaked at postoperative day 1 and remained elevated at postoperative day 2. At postoperative day 7, the VAS scores for groups 1, 2, and 3 began to show signs of further decline, whereas group 4 persisted at postoperative day 5 levels. A general trend of decreasing narcotic use over time and increasing non-narcotic use was noted in each group; however, these findings were not statistically significant. All four groups had nearly identical mean VAS scores and corresponding narcotic use for each postoperative day despite the differing levels of complexity of surgical intervention in each group.