ABSTRACT
OBJECTIVE: The purpose of this article is to review frequently encountered pitfalls as they pertain to the biceps tendon, bursae and cysts around the shoulder, incidental findings, postsurgical findings, and frequently encountered imaging artifacts. CONCLUSION: Imaging pitfalls in and around the shoulder are not limited to normal anatomy and anatomic variants. Radiologists must be cognizant of the vast variability of structures in the shoulder and of the incidental and postsurgical findings and artifacts affecting them.
Subject(s)
Artifacts , Bone Cysts/pathology , Bursa, Synovial/pathology , Magnetic Resonance Imaging/methods , Shoulder/abnormalities , Shoulder/pathology , Tendons/pathology , Bursa, Synovial/abnormalities , Humans , Image Enhancement/methods , Incidental Findings , Postoperative Care , Tendons/abnormalitiesABSTRACT
OBJECTIVE: To use magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and spondylarthropathy (SpA) to determine if the primary site of abnormality differs. METHODS: Twenty patients with recent-onset knee effusion (10 with SpA and 10 with RA) were evaluated using fat-suppressed MRI. Knee joint effusion and synovitis were confirmed using ultrasonography. MRI scans were independently scored by 2 observers who were blinded to the patient's diagnosis. RESULTS: All 10 of the SpA patients, but only 4 of the 10 RA patients, had focal peri-entheseal high signal (compatible with fluid or edema) outside the joint (P = 0.01). Six of the SpA patients had bone marrow edema that was maximal at entheseal insertions; in 4 cases this was multifocal. No RA patients showed such an abnormality (P = 0.01). CONCLUSION: Prominent entheseal abnormalities on MRI are a consistent feature of new-onset synovitis in SpA, but are a minor feature of RA. This finding has important implications for the diagnosis, classification, and mechanisms of synovitis in patients with SpA.
Subject(s)
Knee Joint/diagnostic imaging , Magnetic Resonance Imaging , Spondylitis, Ankylosing/complications , Synovitis/diagnostic imaging , Adult , Bone Marrow Diseases/diagnostic imaging , Bursa, Synovial/abnormalities , Bursa, Synovial/diagnostic imaging , Connective Tissue/abnormalities , Connective Tissue/diagnostic imaging , Edema/diagnostic imaging , Female , Humans , Knee Joint/pathology , Male , Middle Aged , Radionuclide Imaging , Synovitis/complicationsABSTRACT
A patient with congenital isolation of the suprapatellar bursa presented with pain suggestive of patellofemoral joint disease. At arthroscopy, injection filled only the bursa. The diagnosis of congenital isolation of the suprapatellar bursa was made by the injection of radiopaque material into the bursa. Excision of the bursa eliminated the symptoms. This case is instructive, as it documents an unusual congenital anomaly that can complicate arthroscopic technique and can be a rare cause of knee pain.
