Popliteal Arteriovenous Fistula Following Total Knee Arthroplasty.

Postoperative popliteal arteriovenous fistula is a very rare complication. We report a unique asymptomatic fistula in a 77-year-old male patient, seven months after total knee replacement. The diagnosis was suspected by a clinical palpable thrill and confirmed with a typical doppler ultrasound signaling. This vascular malformation was successfully treated by surgical resection of the fistula. Referring to the literature, considering the management of popliteal aneurysms, we suggest to prefer an open procedure in patients who are in good general condition.

ISCHIOFEMORAL IMPINGEMENT DUE TO A SOLITARY EXOSTOSIS.

Ischiofemoral impingement is a rare cause of hip pain related to narrowing of the space between the ischial tuberosity and the lesser trochanter. It is usually seen in middle-aged women. We report a rare case of a young male patient presenting with ischiofemoral impingement due to a solitary exostosis at the lesser trochanter. Imaging, especially Magnetic Resonance Imaging (MRI), is an excellent tool to confirm the diagnosis by demonstrating narrowing of the ischiofemoral space and soft tissue edema in the muscle belly of the quadratus femoris muscle.

Imaging of the spleen: what the clinician needs to know.

The spleen is considered 'the forgotten organ' among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.

Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma.

OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma. MATERIALS AND METHODS: Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared. RESULTS: Fracture detection on CBCT increased by 35% and 37% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236% and 185%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT. CONCLUSION: CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Hepatosplenic Sarcoidosis Complicated by Liver Cirrhosis.

Sarcoidosis is a multisystemic disease usually affecting the lungs and mediastinal lymph nodes. Other organs, such as the liver and the spleen, are less commonly involved. Patients usually present with mild nonspecific symptoms. On imaging, hepatosplenomegaly with or without multiple focal lesions within the spleen may be seen in the active disease stage. Rarely, the disease may evolve to cirrhosis and liver failure. We report such a rare case of hepatosplenic sarcoidosis complicated by acute esophageal bleeding due to portal hypertension.

Plantar Vein Thrombosis: An Unusual Cause of Plantar Pain.

We present a case of an 80-year-old man with progressive pain for 5 days at the medial and plantar aspect of the left heel. Wearing shoes aggravated the pain. Ultrasound and magnetic resonance imaging (MRI) revealed thrombosis of the medial plantar veins. Plantar vein thrombosis is a rare condition. The clinical symptoms are non-specific and can be confused with plantar fasciitis. It has been associated with hypercoagulable conditions, foot trauma and recent surgery. The imaging modality of choice is ultrasound. MRI may add to the diagnosis in unclear cases.

Post-traumatic osteoid osteoma in an 18-year-old adolescent.

Osteoid osteoma (OO) is a painful, benign bone-forming lesion, which often poses a diagnostic challenge. The aetiology of OO is still poorly understood. Although not generally accepted, an association with previous trauma or infection has occasionally been suggested. We present a case of an OO 12 years following an ulnar fracture. Radiologists should consider OO as a potential delayed "complication" of a previous fracture. Persistent pain at a previous fracture site should alert the clinician to request cross-sectional imaging. CT scanning plays a pivotal role in the correct diagnosis of OO.

Stafne Bone Cavity.

BACKGROUND: A 53-year-old male was referred to the department of maxillofacial surgery for the extraction of a destructed wisdom tooth. A preoperative orthopantomogram revealed a well delineated ovoid, radiolucent lesion at the left angle of the mandible. For further lesion characterization, a dental CT scan and MRI were performed.

Primary intraosseous manifestation of Rosai-Dorfman disease: 2 cases and review of literature.

Rosai-Dorman disease (RDD) is a rare disorder of proliferative histiocytes with an unknown etiology. It is also known as sinus histiocytosis with massive lymphadenopathy. Most patients present with painless cervical lymphadenopathy due to accumulation of histiocytes in the lymph nodes, often in conjunction with fever, elevated leukocyte count and erythrocyte sedimentation rate. Isolated skeletal involvement is very rare.

The therapeutic implications of an abdominal aortic aneurysm with coincident horseshoe kidney.

Two male patients were admitted to the department of vascular surgery for treatment of a large infrarenal abdominal aortic aneurysm (AAA) and an associated horseshoe kidney (HSK). Both patients were successfully treated by endovascular aneurysm repair (EVAR). Horseshoe kidney is a rare and complex congenital anomaly, which increases significantly the technical difficulty of conventional surgical repair of an associated AAA. Appropriate preoperative evaluation of the vascular supply of the HSK by CT- angiography and renal function is mandatory for optimal planning of the treatment strategy. EVAR is regarded as a valuable alternative to open surgical therapy, in the absence of renal failure and provided that accessory renal arteries are absent or small.

Amyloidosis: an unusual cause of mesenteric, omental and lymph node calcifications.

We present a rare case of amyloidosis initially presenting with giant calcified inguinal adenopathy. Further imaging revealed diffuse calcifications within the mesentery and greater omentum. Amyloid deposition may mimic chronic granulomatous disorders and primary or secondary neoplastic conditions. Although definite diagnosis is made on histology, the radiologist should include amyloidosis in the differential diagnosis in the absence of a clinical history of neoplastic disorders or chronic infection, especially if extensive intra- lesional calcifications are seen. Ultrasound may be useful to target solid noncalcified areas in easily accessible extra- abdominal locations.