Blunt traumatic right coronary artery dissection presenting with second-degree atrioventricular block and late-onset severe cardiogenic shock.

BACKGROUND: Blunt chest injury may induce several cardiovascular traumata, requiring immediate care. Right coronary artery dissection (RCA) is an extremely rare sequela in this setting and is associated with high mortality, if it remains undiagnosed. Case presentation We present the case of an RCA dissection after blunt chest trauma in a 16-year-old patient, who initially presented with a second-degree atrioventricular block as solitary manifestation on admission. Typical electrocardiographic findings, such as ST segmental changes or pathological Q waves were absent. Serial echocardiograms excluded segmental motion abnormalities, pericardial effusion or right ventricular strain. Nevertheless, a complementary computed tomography coronary angiography revealed this potentially lethal condition several hours later. The patient underwent an emergency surgical myocardial revascularization under the circulatory support of veno-arterial extracorporeal membrane oxygenation and suffered a prolonged right ventricular insufficiency with severe late-onset cardiogenic shock, due to an extensive myocardial infarction of the inferoseptal ventricular wall. CONCLUSION: Right coronary artery dissection after high-speed blunt chest injury constitutes a diagnostic challenge, especially in the absence of typical electrocardiographic and echocardiographic findings in young patients. This condition may dramatically deteriorate in time, leading to severe cardiogenic shock and life-threatening arrhythmias.

Semi-quantitative magnetic resonance imaging scoring of the knee detects previous injuries in professional soccer players.

PURPOSE: The medical examination ("medical") is an important procedure in professional soccer since it has high economic relevance. In addition to clinical tests, magnetic resonance imaging (MRI) is used to assess joint health. In the present study, the reliability of semiquantitative knee MRI during the "medical" in professional soccer was tested, and its relationship with clinical data and days missed due to knee injury was observed. METHODS: In this cross-sectional study, between 2012 and 2019, 69 newly assigned players (age 18-35 years) from a professional soccer club underwent MRI (3.0 T) of both knee joints during their "medical". Reported knee injuries and previously missed days due to injury were obtained from player anamnesis and the "transfermarkt.com" database. Based on the established "Whole-Organ Magnetic Resonance Imaging Score" (WORMS), two independent radiologists graded the MRI results. Further evaluation was based on the mean score of both knees. RESULTS: The mean WORMS for all subjects was 13.9 (median 10.5, range 0-61). Players with previous injuries had significantly higher scores than players without reported injuries (22.1 ± 17.7 vs. 8.9 ± 4.4, p < 0.002). Three outliers (previously undetected injuries) in the group of players without reported injuries were observed (6.7%). The WORMS was significantly correlated with a prior knee injury (r: 0.424, p < 0.0001) and days missed due to injury (r: 0.489, p < 0.001). Age was correlated with the WORMS (r: 0.386, p < 0.001). In a linear regression model, prior injury was the only significant predictor of a high WORMS (p = 0.001). The WORMS was a significant predictor of days missed due to injury (p < 0.0002) and prior injury (sensitivity: 78%, specificity: 91%, p = 0.006). The intraclass correlation coefficient was excellent (0.89). CONCLUSION: Semiquantitative knee MRI for WORMS determination during the soccer "medical" is a robust and reliable method. Prior injury, even in players without documented trauma, was detected by the WORMS, and previously missed days due to injury were correlated with the semiquantitative MR knee score. LEVEL OF EVIDENCE: Level III.

Diagnostic Imaging of Patellofemoral Instability. / Bildgebende Diagnostik der patellofemoralen Instabilität.

BACKGROUND: Throughout the literature, patellofemoral instability (PI) is defined as an increased risk of re-/luxation of the patella within the patellofemoral joint (PFJ). In most patients it is caused by traumatic patella luxation or the existence of a range of predisposing anatomic risk factors leading to an unphysiological movement sequence within the PFJ also known as patellofemoral maltracking. In order to provide an individualized therapy approach, clinical and radiological evaluation of those risk factors of variable magnitude becomes essential. Diagnostic imaging such as magnetic resonance imaging (MRI), plain radiography, and computed tomography (CT) are straightforward diagnostic tools in terms of evaluation and treatment of PI. METHOD: In this review we performed a precise analysis of today's literature concerning the radiological evaluation of anatomic risk factors leading to PI. The purpose of the review is to present a logical compilation of the different anatomical risk factors causing PI and provide a straight overview of valuable radiological imaging techniques. RESULTS AND CONCLUSION: PI is frequently based on a multifactorial disposition. The most relevant predisposing risk factors are trochlea dysplasia, rupture of the medial patellofemoral ligament (MPFL), patella alta, abnormal tibial tubercle to trochlea groove distance (TT-TG), femoral torsion deformities, and genu valgum. Although plain X-rays may provide basic diagnostic value, cross-sectional imaging (MRI, CT) is the standard radiological tool in terms of evaluation and detection of severity of predisposing anatomic variants leading to PI. KEY POINTS: · Based on today's literature, PI is characterized as an increased risk of patella re-/luxation within the PFJ.. · Underlying anatomic risk factors of variable magnitude mark the pathological cause of PI.. · Modern diagnostic imaging (MRI and CT) permits straightforward diagnosis of the typical features in terms of PI.. · To provide an individualized therapy approach, precise radiological evaluation and determination of the severity of predisposing anatomic anomalies are essential.. CITATION FORMAT: · Maas KJ, Warncke ML, Leiderer M et al. Diagnostic Imaging of Patellofemoral Instability. Fortschr Röntgenstr 2021; 193: 1019 - 1033.

Highly reduced-dose CT of the lumbar spine in a human cadaver model.

PURPOSE: Feasibility of a highly reduced-dose lumbar spine CT protocol using iterative reconstruction (IR) in a human cadaver model. MATERIALS AND METHODS: The lumbar spine of 20 human cadavers was repeatedly examined using three different reduced-dose protocols (RDCT) with decreasing reference tube current-exposure time products (RDCT-1: 50 mAs; RDCT-2: 30 mAs; RDCT-3: 10 mAs) at a constant tube voltage of 140 kV. A clinical standard-dose protocol (SDCT) served as the reference (reference tube current-exposure time product: 70 mAs; tube voltage: 140 kV). Images were reconstructed using filtered back projection (FBP) and two increasing levels of IR: IRL4 and IRL6. A five-point scale was used by two observers to assess the diagnostic quality of anatomical structures (cortical and trabecular bone, intervertebral foramina, pedicles and intervertebral joints, spinous and transverse processes). Objective image noise (OIN) was measured. Results were interpreted using a linear mixed-effects regression model. RESULTS: RDCT-2 with IRL6 (1.2 ± 0.5mSv) was the lowest reduced-dose protocol which provided diagnostically acceptable and equivalent image quality compared to the SDCT (2.3 ± 1.1mSV) with FBP (p > 0.05). All RDCT protocols achieved a significant reduction of the mean (±SD) effective radiation doses (RDCT-1: 1.7±0.9mSv; RDCT-2: 1.2±0.5mSv; RDCT-3: 0.4±0.2mSv; p < 0.05) compared to SDCT. OIN was lower in all RDCT protocols with the application of IRL4 and IRL6, compared to the SDCT with FBP (p < 0.05). CONCLUSION: Highly reduced-dose lumbar spine CT providing diagnostically acceptable image quality is feasible using IR in this cadaver model and may be transferred into a clinical setting.