Longitudinal epiphyseal bracket.

A longitudinal epiphyseal bracket (LEB) is a defect of the tubular bones and has been primarily described in the hands and feet, especially the proximal phalanges, metacarpals, and metatarsals. The LEB results from a defective C-shaped secondary ossification center that brackets the diaphysis and metaphysis, causing restricted longitudinal growth in these bones with resultant shortening and angular deformities. Deformities associated with metatarsal epiphyseal bracket include a short, broad metatarsal and medial deviation of the metatarsophalangeal joint (hallux varus deformity). Excision of the cartilaginous LEB has been proposed to prevent future soft tissue contractures and osseous deformities. The LEB has been associated with numerous syndromes including Rubinstein-Taybi syndrome, Cenani-Lenz syndactyly, isolated oligosyndactyly, and Nievergelt syndrome. We describe a two-month-old patient in whom plain film and MR imaging demonstrated bilateral bracketed first metatarsals with associated hallux varus deformities. Bilateral bracket excision was performed with excellent clinical results.

Calcaneal osteochondroma.

Osteochondromas are essentially the most common primary bone tumors. These benign cartilage producing neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. HME, the familial form of this tumor, is associated with a greater incidence of complications, the most significant of which is sarcomatous degeneration to secondary chondrosarcomas. Various imaging techniques can be used to characterize these lesions, but in the absence of symptoms or signs of complications, plain-film radiography is usually sufficient for diagnosis as this tumor has a characteristic radiographic appearance. Once this benign tumor is identified and more serious forms of tumor are ruled out, treatment is generally not needed. If a malignancy is suspected, however, complete surgical excision is the preferred treatment as this usually ensures long term survival.

Disruption of the inferior popliteomeniscal ligamentous fascicle.

The superior popliteomeniscal ligamentous fascicular injury association with lateral meniscal injury has been previously documented in the literature. Both superior and inferior popliteomeniscal ligamentous injuries have demonstrated associations with lateral meniscal motion, and these ligaments can be disrupted in posterolateral corner knee injuries as well. The current case demonstrates an unusual case of isolated inferior popliteomeniscal ligamentous fascicular injury. We examine and discuss its association with the superior popliteomeniscal ligament, posterolateral corner injuries and the fascicular relationship to lateral meniscal tears.

Intramedullary insertion of the patellar tendon.

This case represents a rare presentation of an intramedullary insertion of the patellar tendon in an otherwise healthy 8-year-old girl. To our knowledge no such phenomenon has previously been reported in the English literature.

Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty.

OBJECTIVE: To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. DESIGN: Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. PATIENTS: Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. RESULTS AND CONCLUSIONS: At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined.

Developmental venous anomalies and cavernous angiomas: a review of the concurrence, imaging, and treatment of these vascular malformations.

Deep venous anomalies and cavernous angiomas are two distinct intracranial lesions. Although these lesions can be found in association with each other, they have different pathologic characteristics and developmental mechanisms. These lesions can produce a variety of clinical symptoms or in some cases can be asymptomatic. The management of these anomalies can include conservative measures in some cases and aggressive intervention in others. Several imaging modalities can be used to evaluate these distinct lesions and often more than one are needed for a prompt and reliable diagnosis. Because of the tendency of these lesions to occur simultaneously, thorough evaluation of these anomalies and their surrounding tissues is critical in their clinical management. In this review, the characteristics and radiographic evaluation of these lesions will be presented and the therapeutic options for these anomalies will be discussed.

Pubic symphyseal width in pediatric patients.

Traditionally, there has been no readily available and statistically sound method for evaluating the normal pubic symphyseal width in children. Normal values for the width of the pubic symphysis in the pediatric population are useful for determining pathologic widening, either congenital or posttraumatic. This investigation was directed at determining a reference range for the normal pubic symphyseal width according to age, age group, gender, and when combining these variables. Overall, the study found that the normal measurement for pediatric pubic symphyseal width ranges from 0.52 to 0.84 cm. The data also showed that the mean pubic symphyseal width for all variables combined was 0.68 cm (standard deviation of 0.16 cm and a 95% confidence interval of 0.668 to 0.690) and that anything greater than 0.84 cm needs further evaluation for pathology. The interclass correlation coefficient, test of interrater reliability, yielded moderate reliability of measurements between physicians.

Hemophilic pseudotumor.

Bleeding diatheses are a hallmark of hemophilia. Hemophilic pseudotumor results from multiple episodes of hemorrhage into bones or soft tissue spaces. It is uncommon and is seen in severe cases of hemophilia only 1-2% of the time. Complications and symptoms arise due to pain and/or compression of surrounding structures. Pathologic fractures can be associated with intraosseous lesions and can result from bone destruction or resorption due to the chronic pressure of an osseous hemorrhage. Radiographs may demonstrate expansile lesions of the bones or increased soft tissue density that may be associated with extra osseous lesions. Bleeding may also occur within the joint space. These intra-articular hemorrhages can, over time, result in hemophilic arthropathy. The following case report demonstrates both an expansile lesion of a metacarpal as well as hemophilic knee arthropathy in an 11 year old.

Imaging findings of femoroacetabular impingement syndrome.

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement-cam impingement and pincer impingement-are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms.

Magnetic resonance imaging findings of chronic lateral ankle instability.

The ankle inversion injury is one of the most common types of injury that is encountered in athletes and active individuals. There are a wide variety of acute injuries associated with ankle inversion, including peroneal tendon tears, osteochondritis dessicans of the talus, anterior talofibular ligament avulsion, peroneal retinaculum avulsion, and calcaneofibular ligament tears. Chronic sequelae include impingement, posttraumatic degenerative arthritis, and an attenuated peroneal retinaculum. Most inversion injuries to the ankle have multiple associated injuries and isolated ligament injuries are uncommon. Chronically, the injured ankle usually demonstrates the injuries found at the time of the initial injury. Subsequently, there is a high frequency of these injuries in patients evaluated for symptoms of chronic lateral ankle instability. A high index of suspicion for the specific types of injuries associated with ankle inversions may result in a higher rate of injury detection and more expeditious and accurate diagnoses. Given the persistence of these injuries seen in patients with chronic posterolateral instability, injury patterns of ankle inversion are important to recognize even in the absence of acute trauma. We review the various types of injuries with their associated magnetic resonance (MR) imaging characteristics seen in patients with chronic lateral ankle instability.

A case of osteochondritis dissecans in rickets.

Rickets and the decreased ossification associated with it can give rise to abnormally low bone density and weakened osseous structures. Despite this association, rickets has rarely been associated with osteochondral defects, and the imaging findings of this association have not been previously described on magnetic resonance (MR) imaging. This case report presents an adolescent male with a clinical history of rickets and recent-onset knee pain that was determined to be caused by bilateral osteochondritis dissecans. Prompt recognition of osteochondritis dissecans is important, as this entity is a treatable cause of knee pain.

Cystic masses of the knee: magnetic resonance imaging findings.

Cystic masses of the knee comprise a diverse group of pathologic entities ranging from simple cysts to complications of underlying disease to tumors. Although their presentations may be similar, the appropriate treatment and patient management can differ greatly. In this article, we review radiographic and magnetic resonance imaging characteristics of both common and uncommon cystic masses of the knee.

Paravertebral bronchogenic cyst diagnosed by computed tomography-guided biopsy.

Bronchogenic cysts are lesions that are an anomaly of congenital development. Although most are found in the mediastinum, bronchogenic cysts can be found in many different anatomical positions in the body and can have multiple presentations. These lesions can be asymptomatic and found incidentally, or they can present with specific symptoms. Bronchogenic cysts can be diagnosed on multiple radiographic modalities including conventional radiography, computed tomography, and magnetic resonance imaging. Most are treated conservatively but the possibility of infection or malignant transformation has caused some clinicians to recommend invasive treatment for these lesions. This article presents a case report of the diagnosis and management of a paravertebral bronchogenic cyst in a 64-year-old female.

The symptomatic accessory navicular bone: a report and discussion of the clinical presentation.

An accessory navicular bone is a congenital anomaly caused by aberrant ossification. Usually asymptomatic, they are relatively common in our population. They can present in several different locations, which can have an impact on the clinical presentation and the degree of dysfunction. Occasionally, these can become symptomatic, which can manifest as chronic or acute on chronic foot pain. Diagnosis of this condition relies on radiographic evaluation. The 45-degree eversion oblique view of the foot is the most important view for identifying this condition, although several different imaging techniques can be used. Treatment of this condition includes both surgical and nonsurgical options. Ultimately, surgery yields the best outcome for young patients, though conservative management has relevance for less active patients. The following case demonstrates the presence of a symptomatic accessory navicular bone in a young athlete.