Imaging of head and neck lipoblastoma: case report and systematic review.

Lipoblastoma is a rare and benign tumour arising from embryonal fat cells, predominantly diagnosed in children younger than 3 years old. The most frequent locations are the extremities and trunk, while the head and neck areas are more rarely affected (10-15% of total cases). Clinically, the most common presentation is a fast-growing painless mass. Ultrasound is the first-line imaging examination, but Magnetic Resonance Imaging (MRI) allows for better definition of the relationships with the adjacent vascular and muscular structures. It can help to identify the lipomatous components, and it is useful for preoperative planning. However, the definitive diagnosis is provided by histopathological examination. Complete surgical excision is the first-line treatment, with a good prognosis in case of total eradication. We report the case of a 7-month-old male child with a rapidly growing mass that had typical radiological features of lipoblastoma.

Ultrasound and Magnetic Resonance Imaging Diagnosis of Isolated Tear of the Accessory Soleus Tendon: A Case Report and Review of the Literatures.

INTRODUCTION: The accessory soleus muscle (also known as the supernumerary soleus or soleus secundus) is an uncommon congenital anatomical. The presence of this muscle is generally asymptomatic. In cases of symptomatic accessory soleus muscle, it manifests with painful swelling of the posteromedial region of the ankle. To the best of our knowledge, partial or complete accessory soleus tendon tears were reported in literature in only three cases; all of them were diagnosed with magnetic resonance imaging (MRI) examination while only one was diagnosed with both ultrasound (US) and MRI. CASE REPORT: We presented a case of a 63-year-old Caucasian woman presented to our emergency department with severe pain in the posteromedial region of her right ankle. US and MRI of the calf and ankle were performed and a complete tear of the right accessory soleus tendon with fluid gap and myotendinous retraction was diagnosed. CONCLUSION: An accessory soleus muscle partial or complete tears are very uncommon injuries. This condition can mimic many other pathologies, and therefore, radiologists should know the physiological and pathological imaging findings for a correct interpretation of ankle injuries, avoiding misinterpretations.

Secondary aneurysmal bone cyst in Langerhans cell histiocytosis: Case report, literature review.

Langerhans cell histiocytosis (LCH) is a rare disease of the myeloid precursor cells, it predominantly occurs in the skull and long bones as unifocal bone lesions. Aneurysmal bone cysts (ABC) are benign, expansive and lytic bone. Reports of secondary ABC occurring in LCH are rare, having only been reported twice in the skull. Here, we report the first case of LCH masquerading as ABC in a 14-month-old female child who presented with a rapidly growing mass in her left femur. The lesion had typical radiological features of ABC, and only histological examination revealed the presence of cells suggestive of LCH.

Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study.

AIM: The etiology, pathogenesis and natural course of Achilles tendinopathy are not yet completely known. Various forms of therapies, either conservative or surgical, have been proposed for its treatment. In the last few years, extracorporeal shockwave therapy (ESWT) has been proposed in the treatment of these tendinopathies and has shown encouraging short-term results. The purpose of this type-C study was to evaluate the effectiveness of ESWT in the symptomatic treatment of Achilles tendinopathies over time. METHODS: One hundred five patients (127 tendons) aged between 18 and 74 years (mean age 47.8) were enrolled in this study. All patients underwent clinical and instrumental diagnosis (ultrasonography, magnetic resonance imaging and X-rays) in order to identify presence, location and seriousness of the specific tendinopathy. The symptomatology was classified using the Visual Analogical Scale (VAS) and according to a five-stage clinical evaluation range. Shock wave treatment was applied with an electromagnetic shock wave generator. The protocol consisted in an average of four sessions (minimum three, maximum five), at a 2/7-day interval. In each session 1 500-2 500 impulses were administered with an energy varying between 0.08 and 0.40 mJ/mm2. All patients were evaluated before therapy and two months after the last ESWT session. Also, all patients were assessed and evaluated at medium-term (6 to 12 months), and 121 patients also at long-term (13 to 24 months). RESULTS: Authors obtained satisfactory results in 47.2% of cases (60 out of 127 tendons) at two-months follow-up, which increased to 73.2% at medium-term follow-up (93 out of 127 tendons), and then reaching 76% in the last evaluation (92 out of 121 tendons). CONCLUSIONS: The outcome of the described shock wave treatment appears to be satisfactory and confirms the role of this alternative treatment in the management of the tendon disorders.

[Liver scintigraphy using 99mTc-HIDA in the study of biliary-digestive anastomosis]. / La scintigrafia epato-funzionale con 99mTc-HIDA nello studio delle anastomosi bilio-digestive.

Surgical operations characterised by the creation of a bilio-intestinal anastomosis are becoming an increasingly frequent procedure in bile tract surgery. Just as frequent and well known are the immediate and longer-term postoperative sequelae. Thus, one of the problems which has always interested surgeons and investigators is how best to monitor the functional efficiency of the anastomosis. Traditional x-ray methods, including highly invasive examinations such as PTC and ERCP, as well as the harmless ultrasound procedures do not provide an adequate picture of the functional efficiency of such anastomoses, the only wholly valid and efficacious method being sequential scintigraphy with 99mTc-Hida. On the basis of these principles, the authors describe their experience in this field, stressing the validity of the method, which enables surgeons to study the morphology and, above all, the functional efficiency of bilio-intestinal anastomoses.

[A case of spontaneous hematoma of the rectus abdominis muscle]. / Su di un caso di ematoma spontaneo del muscolo retto addominale.

The authors describe a recently observed case of spontaneous hematoma of the abdominal rectus muscle. They go on from there to a thorough examination of this rare condition in the light of the latest contributions on the subject in the literature. After describing the anatomo-pathological, aetiopathogenetic and clinical aspects of the condition, the authors deal at some length with the diagnostic possibilities afforded by ultrasound in particular and with the indications for conservative therapeutic treatment, surgery being resorted to only in complicated cases or in cases where diagnostic doubts persist.

[Clinical comments on a case of retroperitoneal lipoma]. / Considerazioni cliniche su di un caso di lipoma retroperitoneale.

The authors show a case of retroperitoneal lipoma, histologically ascertained; they state its origin and the clinical features, and analyse the different diagnostical methods, particularly dwelling upon urography, TC and selective arteriography. They, at last, point out such pathology, although benign, is burdened by a high risk of relapses and by the possibility to turn into malignant. As a conclusion, they assert the importance of the radicalness of the intervention, joined to bioptic drawings in different parts of the tumor extirpated, with the purpose to identify, as precociously as possible, an eventual malignant degeneration of the same lipoma.

[A case of intestinal occlusion caused by a Meckel' diverticulum (etiopathogenetic, diagnostic and clinical considerations)]. / Su di un caso di occlusione intestinale da diverticolo di Meckel (Considerazioni etiopatogenetiche, diagnostiche e cliniche).

The authors show a case of acute intestinal stoppage due to Meckel's diverticulum. After some notices about embryogenesis, pathological anatomy and symptomatology of Meckel's diverticula, they point out the difficulty to reach the diagnosis of such disease, which almost always is only done subsequent to the appearance of complications, such as: intestinal stoppage, inflammation, ulceration, perforation, neoplasms, bleeding. In fact, the diagnosis of Meckel's diverticulum is exceptionally preoperative and difficult on the basis of the symptomatology only, for which the disease can be responsible, whereas it can be more easily placed thanks to the contribution of instrumental methods, such as: barium meal, opaque enema, scintigraphy with 99mNa pertechnetate, selective arteriography of upper mesenterial artery. The diagnosis is more frequently interoperative, in course of explorative laparotomy or performed for other indications. Then the Authors state their orientation about the treatment, which is surgical in all the complex cases of Meckel's diverticulum, with a mention of the different operative techniques, and, as a conclusion, confirm the necessity for the systematic research of the asymptomatic diverticulum, the removal of which represents the only prophylactic measure against a permanent possibility and dreadful complicative evolution of same.

[Clinical considerations on diverticula of the duodenum]. / Considerazioni cliniche sui diverticoli del duodeno.

The authors, in the light of the data supplied by the literature, and through a careful analysis of their recent casuistry, based upon the observation of 48 cases of duodenal diverticula, propose a modern reviewing of the topic. After illustrating the etiopathogenetic, anatomo-pathological and clinical features of such disease, the Authors dwell upon the diagnostic and therapeutical problems involved, and point out the importance of a correct diagnostic iter and a consequent exact surgical indication. As a conclusion, they affirm the surgical treatment of duodenal diverticula, not exempt from risks, should be only reserved to cases rebellious to the medical treatment or severely complicate.