The effects of hyperbaric oxygen on MRI findings in rheumatoid arthritis: A pilot study.

Background: Rheumatoid arthritis is a debilitating and destructive disease for which limited therapeutic options exist. Objective: This report summarizes serial magnetic resonance imaging (MRI) findings from nine study participants treated with hyperbaric oxygen (HBO2) therapy and expands upon an earlier pilot study that showed improvement in disease activity and joint pain as determined by multiple, validated clinical measures. Methods: Rheumatoid arthritis patients received 30 hyperbaric oxygen treatments over six to 10 weeks. MRI with and without contrast was completed at baseline, and at three- and six-month intervals following initiation of HBO2 therapy. Ratings were based on Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) criteria, the standard method for quantification of inflammation and damage by MRI in RA trials. Results: Using RAMRIS criteria, nine of nine patients demonstrated no radiologic progression of erosions, synovitis, or bone marrow edema at three- and six-month scans. Conclusion: Our findings suggest that HBO2 therapy may be useful as an adjunctive or alternative treatment to disease-modifying drugs for rheumatoid arthritis.

Hawkins sign of the knee: Imaging appearance and clinical implication of an unusual pattern of disuse osteopenia.

Disuse osteopenia (DO) is a disorder due to reduced weight-bearing often following immobilization injuries. It is most commonly observed in the ankles and knees and is believed to be due primarily to increased bone reabsorption associated with disuse. Both traditional radiography and magnetic resonance (MR) imaging are useful in identifying abnormalities associated with DO. Specifically, linear subchondral osteopenia has been given the term "Hawkins sign" when seen in the talus, but this finding may also be seen elsewhere. When present, it not only is an indication of DO but also indicates the presence of sufficient vascular flow, and the unlikely development of avascular necrosis. We report a case of Hawkins sign of the knee demonstrated on radiography and MR and demonstrate the clinical importance of recognizing this sign, outside its usual setting, in assessing the prognosis of a healing fracture.

The Effects of Hyperbaric Oxygen on Rheumatoid Arthritis: A Pilot Study.

BACKGROUND/OBJECTIVE: This case series pilot study assessed the effects of hyperbaric oxygen therapy (HBO2) for treating rheumatoid arthritis (RA). METHODS: Ten RA subjects received 30 HBO2 treatments over 6 to 10 weeks. Serial rheumatologic evaluations (ie, the Disease Activity Scale [DAS28], the Routine Assessment of Patient Index Data 3, and the Pain and Sleep Quality Questionnaire) were completed at baseline, throughout the course of the study, and at the 6-month follow-up. RESULTS: There was a statistically significant effect of HBO2 therapy over time on the DAS28-Global Health (p = 0.01), the DAS28-C-reactive protein (p = 0.002), and the DAS28-erythrocyte sedimentation rate (p = 0.008) measures; these analyses excluded 2 patients who were in clinical remission at baseline. Selected post hoc comparisons showed significantly lower DAS28-Global Health, DAS28-C-reactive protein, and DAS28-erythrocyte sedimentation rate scores at 3 and 6 months relative to baseline. In addition, statistically significant decreases in pain as measured by the Routine Assessment of Patient Index Data 3 and Pain and Sleep Quality Questionnaire were observed at the end of HBO2 relative to baseline. CONCLUSIONS: Hyperbaric oxygen therapy is effective for joint pain in patients with RA based on data from multiple, validated clinical measures. Further research with more subjects and the use of a control group is necessary.

Hot shoulder PET/CT lesion: Unusual presentation of tenosynovial giant cell tumor.

We present a case of a tenosynovial giant cell tumor (TGCT) incidentally discovered at the shoulder on PET/CT, in a patient with history of thyroid cancer. Many documented cases of TGCT have been incidentally imaged by PET/CT and have been found to have varying levels of metabolic activity, however the shoulder location is unusual. This type of musculoskeletal lesion often has MRI characteristics, such as gradient echo blooming, which can render a confident diagnosis without need for biopsy.

Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.

Piriformis syndrome is an uncommon condition that causes significant pain in the posterior lower buttocks and leg due to entrapment of the sciatic nerve at the level of the piriformis muscle. In the typical anatomical presentation, the sciatic nerve exits directly ventral and inferior to the piriformis muscle and continues down the posterior leg. Several causes that have been linked to this condition include trauma, differences in leg length, hip arthroplasty, inflammation, neoplastic mass effect, and anatomic variations. A female presented with left-sided lower back and buttock pain with radiation down the posterior leg. After magnetic resonance imaging was performed, an uncommon sciatic anatomical form was identified. Although research is limited, surgical intervention shows promising results for these conditions. Accurate diagnosis and imaging modalities may help in the appropriate management of these patients.

Acute exertional medial compartment syndrome of the foot in a teenager.

Acute compartment syndrome is an emergent condition characterized by increased pressure in a noncompliant fascial compartment, resulting in ischemia of the muscles and nerves. It is most commonly caused by a traumatic etiology but rarely can be caused by an atraumatic etiology, resulting in a confusing clinical scenario. We present a case of a 15-year-old sedentary teenager diagnosed with acute exertional medial compartment syndrome of the foot, initially diagnosed with MRI, following two days of rugby practice.

Infected dermoid sinus tract mimicking recurrent sinusitis in an adolescent male.

Nasal dermoid sinus cysts are the most common congenital midline nasofrontal masses, but they can easily be confused with simple recurrent sinusitis upon clinical presentation. We report the case of a 14-year-old male who was initially diagnosed with frontal sinusitis and treated with antibiotics but, after multiple episodes of recurrence, was later sent for imaging. Computed tomography and magnetic resonance imaging showed an infected dermoid sinus tract. Subsequent surgery removed the mass and pathologic investigation proved the diagnosis.