Ultrasound guided alcohol ablation of Morton's neuroma.

BACKGROUND: Morton's neuroma is a common cause of metatarsalgia. This study evaluated the efficacy of ultrasound guided alcohol injection as a treatment for this condition. METHOD: Data from 87 treatment courses were included in this study with a mean follow of 14.3 months. RESULTS: Technical success was 100%. One patient developed symptoms consistent with an allergic reaction to the injection and one patient declined further injection because of periprocedural pain. Partial or total treatment response was achieved in 66%, with 32% of patients having complete resolution of pain. The median visual analogue score (VAS) decreased from 8 pre-procedure to 4 post-procedure (p < 0.0001). Procedural success was greater in patients under 55 years old and in those with solitary neuromas. Seventeen patients (20%) went on to have surgery due to continuing pain. CONCLUSION: Ultrasound guided alcohol ablation for the treatment of Morton's neuroma was a safe procedure that significantly reduced pain and may offer an alternative therapy to surgery.

Gas patterns on plain abdominal radiographs: a pictorial review.

Abdominal radiographs are one of the most commonly performed radiological examinations and have an established role in the assessment of the acute abdomen. The main indication is for suspected bowel obstruction and in conjunction with an erect chest x-ray for suspected visceral perforation. Often, the pattern of gas points to a particular pathology, and accurate interpretation is important for prompt diagnosis. The diagnosis in most cases will be confirmed by further imaging studies such as ultrasound, contrast studies or, most commonly in contemporary practice, CT. This pictorial review summarises the various types of intraluminal and extraluminal gas patterns, illustrates some of the common clinical diagnoses made from plain films, describes some commonly encountered clinical problems with radiographs, and discusses the role of advanced imaging techniques.

Imaging in childhood scoliosis: a pictorial review.

Childhood scoliosis is a common clinical entity with a number of different causes. In the majority of cases, the scoliosis is idiopathic, but it may be the manifestation of an occult spinal pathology. The clinical history and examination may elicit certain worrying features such as pain, neurological symptoms or an atypical curve pattern. These findings should prompt advanced imaging, as early and accurate detection of an underlying cause allows optimal planning and timing of surgery and helps reduce associated risks. The most common occult pathologies detected by advanced imaging are Arnold Chiari malformations, syringohydromyelia and closed spinal dysraphism such as diastematomyelia. Advanced imaging techniques, in particular multiplanar MRI, are also increasingly requested in children with known congenital scoliosis associated with spinal dysraphism and developmental causes of scoliosis such as neurofibromatosis and Klippel-Feil syndrome, as it allows superior delineation of the spinal column without the radiation risk. This review aims to examine the different imaging techniques currently used in the evaluation of scoliosis and provide a pictorial summary of the more common causes and associations.