Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice.

Hoffa's (infrapatellar) fat pad (HFP) is one of the knee fat pads interposed between the joint capsule and the synovium. Located posterior to patellar tendon and anterior to the capsule, the HFP is richly innervated and, therefore, one of the sources of anterior knee pain. Repetitive local microtraumas, impingement, and surgery causing local bleeding and inflammation are the most frequent causes of HFP pain and can lead to a variety of arthrofibrotic lesions. In addition, the HFP may be secondarily involved to menisci and ligaments disorders, injuries of the patellar tendon and synovial disorders. Patients with oedema or abnormalities of the HFP on magnetic resonance imaging (MRI) are often symptomatic; however, these changes can also be seen in asymptomatic patients. Radiologists should be cautious in emphasising abnormalities of HFP since they do not always cause pain and/or difficulty in walking and, therefore, do not require therapy. Teaching Points • Hoffa's fat pad (HFP) is richly innervated and, therefore, a source of anterior knee pain. • HFP disorders are related to traumas, involvement from adjacent disorders and masses. • Patients with abnormalities of the HFP on MRI are often but not always symptomatic. • Radiologists should be cautious in emphasising abnormalities of HFP.

Sonographic anatomy of the ankle.

Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures.

Enthesitis of the direct tendon of the rectus femoris muscle in a professional volleyball player: A case report.

Enthesitis of the direct tendon of the rectus femoris muscle is a rare pathology which mainly affects professional athletes, and it is caused by overuse and repetitive microtrauma. Athletic jumping and kicking exert a great stress on the direct tendon of the rectus femoris muscle, and volleyball and football players are therefore most frequently affected. Enthesitis may occur suddenly causing pain and functional impairment possibly associated with partial or complete tendon injuries, or it may be a chronic condition causing non-specific clinical symptoms.We present the case of a professional volleyball player who felt a sudden pain in the left side of the groin area during a training session although she had suffered no accidental injury. The pain was associated with impaired ipsilateral limb function. Tendon rupture was suspected, and magnetic resonance imaging (MRI) was performed. MRI showed a lesion at the myotendinous junction associated with marked inhomogeneity of the direct tendon. Ultrasound (US) examination confirmed the presence of both lesions and allowed a more detailed study of the pathology.This is a typical case of enthesitis which confirms that MRI should be considered the examination of choice in hip pain, particularly when the patient is a professional athlete, thanks to its panoramic visualization. However, also US is an ideal imaging technique for evaluating tendon injuries thanks to its high spatial resolution, and it can therefore be used effectively as a second line of investigation.

Ultrasonography of the male breast.

The male breast has been insufficiently explored in the medical literature, particularly that dealing with ultrasonography, although this topic is almost as vast and varied as that of the female breast. The purpose of this article is to provide a schematic review of the most frequent breast lesions encountered in males and their sonographic appearances. After a brief introduction on the anatomy of the male breast, the authors review the non-neoplastic (gynecomastia, pseudogynecomastia, cysts, inflammatory diseases, and Mondor disease) and neoplastic (benign and malignant) lesions encountered in this organ.

Dorsal forearm muscles: US anatomy Pictorial Essay.

THE DORSAL COMPARTMENT OF THE FOREARM CONTAINS NINE MUSCLES: four belong to the superficial group (extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris and anconeus) and five to the deep group (supinator, abductor longus, extensor pollicis brevis, extensor pollicis longus, and extensor indices). Of these nine muscles the following details are considered: origin, course, distal insertion and their anatomical connection with those structures which are most often affected by pathologies. The radiologist must have a thorough knowledge of this complex topographic anatomy in order to perform ultrasound (US) and magnetic resonance imaging (MRI) examinations and correctly interpret the images.

Power Doppler ultrasound of gallbladder wall vascularization in inflammation: clinical implications.

We investigated the role of Power Doppler US in the diagnosis and follow-up of cholecystitis. We reviewed the examinations of 21 surgical patients aged 27-48 years with US findings of cholecystitis. We performed B-mode and then Power Doppler US. Wall thickness and US structure, the presence/absence of stones, and US Murphy's sign were assessed at B-mode US, whereas only the presence/absence of wall vascularization was studied with Power Doppler. B-mode and Power Doppler changes post treatment were also investigated. Ultrasound showed wall thickening in all patients. In addition, positive Murphy's sign and/or gallbladder stones were seen in 6 patients each at B-mode US and wall vascularization in 7 patients with Power Doppler. Acute cholecystitis was diagnosed in these patients. The other 14 patients presenting wall thickening but no vascularization and negative US Murphy's sign were diagnosed as having chronic cholecystitis; 10 of them had gallbladder stones. Two of seven acute cholecystitis patients were operated on in the acute stage for the onset of complications and histologic findings confirmed the US diagnosis. As for the remaining patients, histology diagnosed chronic cholecystitis in 17, whereas wall thickening was not inflammatory in 2 cases. All the cases with early wall vascularization were eventually diagnosed as cholecystitis. Power Doppler US permits confirmation of the diagnosis of acute cholecystitis and distinguishing of chronic disease, which helps in planning of surgery.

[Assessment of varicocele recurrence with ultrasonography, color and power Doppler]. / Valutazione delle recidive del varicocele con ecografia, color e power doppler.

To study the postoperative recurrences of varicocele and the relationship between recurrences and sperm variables, we reexamined postoperatively 48 patients aged 14-56 years (mean: 25 years); the patients returned within a time range of 4 to 36 months. All the patients underwent physical examination, B-mode, color and power Doppler sonography (US); the images were acquired with the patient both supine and upright, both at rest and during Valsalva maneuver. We studied the incidence of recurrences and their bilaterality, the presence of reflux with or without functional maneuvers, associated conditions, surgical complications and the improvement of sperm variables; color and power Doppler findings were compared. The incidence of recurrences (28) and that of major complications (2) were related to the type of surgery: thus, no complications but 26 recurrences were found in the patients with spermatic vein ligation, versus only 2 recurrences but also 2 major complications (1 testicular ischemia and 1 hydrocele) in the patients with ligation of the spermatic cord venous channels. A right varicocele was found in 12 patients, which confirmed the frequent bilaterality of this condition; 8 patients with recurrences had improved sperm variables and 6 presented associated conditions. Our trial confirms that B-mode US, combined with color and power Doppler, can show recurrences, bilaterality, surgical complications and associated conditions and emphasize the role of these exams in the postoperative follow-up of varicocele. However, no method alone, without the evaluation of sperm variables, permits to select the patients to be reoperated on.

[Direct radiographic enlargement in mammography in everyday practice. Indications and limitations]. / Ingrandimento radiografico diretto nella mammografia nella pratica quotidiana. Indicazioni e limiti.

One thousand mammograms of non-preselected patients were reviewed in order to assess in how many and which cases an equivocal diagnosis can be made unquestionable and to test the value of follow-up exams with direct radiographic magnification. Direct radiographic magnification was used in all questionable cases (3%): 18 lesions were characterized by microcalcifications and 12 by nodules. Four cases were diagnosed as unquestionable (13%)-1 microcalcification and 3 nodules-while 13 patients were reexamined with mammography only. Even though the percentage variation from equivocal to unquestionable diagnoses is modest but significant, direct radiographic magnification is always useful in the follow-up.

[Significance of Harris' lines in fractures of the legs. Review of 53 cases]. / Significato delle strie di Harris nelle fratture degli arti inferiori. A proposito di 53 casi.

Metabolic deficiencies of various kinds, acute or chronic diseases, and especially bone fractures may cause the formation of transverse thickening lines--known as Harris' lines--in bone metaphysis. The authors have selected 53 cases of lower limbs fractures in young people from their clinical reports and studies. These reports included X-ray studies or other data allowing comparison of the injured segment at a significant time interval from trauma. The importance of Harris' lines, which appear in a high percentage of cases, is discussed also from a medical jurisprudence point of view, as these lines clearly indicate the time when the fracture occurred and the subsequent evolution of the repair process.

[Milk of calcium renal lithiasis: uro-echographic evaluation]. / Litiasi renale a "latte di calce": valutazione uro-ecografica.

From the fortuitous observation of a rare case of "milk of calcium" lithiasis in a renal calyceal diverticulum, the authors, having examined the etiopathogenetic implications of the disease and having considered the problems of differential diagnosis, discuss whether urography and sonography are a valid means of making a correct diagnosis and the consequent implications of a therapeutic nature which this pathology would involve.

[CT in the evaluation of the extension of bronchogenic carcinoma]. / La T.C. nella valutazione dell'estensione del carcinoma broncogeno.

The computed tomographic patterns in 52 patients with histologically proven lung cancer are reported. The AA. underline the not sobstitutive role of C.T. scan in pre-operative determination of bronchogenic carcinoma extension. C.T. revealed a very high diagnostic accuracy in assessing the primary tumor extension and in evaluating distant macrometastases; however, in showing hilar and mediastinal nodal involvement has not the same accuracy. The AA. think that, at the present time, a combinate C.T. study of the chest, upper abdomen and brain is, in the most number of cases, a rapid, accurate and practical method to evaluate the extension of lung cancer.