Sonographic and Magnetic Resonance Imaging Examination of a Cyclops Lesion After Anterior Cruciate Ligament Reconstruction: A Case Report.

OBJECTIVE: This case report describes magnetic resonance imaging (MRI) and diagnostic ultrasound (US) findings for a patient with arthrofibrosis related to a complication of anterior cruciate ligament (ACL) reconstruction. CLINICAL FEATURES: A 25-year old man presented with right knee pain and loss of extension 5 years after ACL reconstruction. MRI and sonographic examination revealed a soft tissue mass anterolateral to the ACL graft consistent with a cyclops lesion. The lesion was surgically resected and physical therapy was followed postoperatively. INTERVENTION AND OUTCOME: The patient reported that full range of motion was restored 6 weeks after resection and a course of physical therapy. MRI is the modality of choice for diagnosis, but US may be useful in the diagnosis of this condition. CONCLUSION: Cyclops lesions may complicate ACL reconstruction or acute ACL injuries. The patient may present with pain and loss of extension, which can be debilitating. MRI and US can be used to diagnose this condition in a timely manner, ensuring optimal clinical outcomes.

An Unusual Case of Polyostotic Fibrous Dysplasia in a 53-Year-Old Woman With Low Back Pain.

OBJECTIVE: The purpose of this case report is to describe the features of an unusual presentation of fibrous dysplasia. CLINICAL FEATURES: A 53-year-old woman had low back pain and numbness in the anterior upper left thigh that started 3 years earlier after a fall. She experienced pain during active lumbar flexion and extension range of motion. Radiographic examination demonstrated an oval geographic osteolytic lesion in the left ilium and abnormal trabecular architecture with variable-sized osteolytic lesions and both ill-defined and well-defined borders along the sacroiliac joint margin. INTERVENTION AND OUTCOME: Because of the aggressive osteolytic appearance, magnetic resonance imaging of the pelvis with gadolinium contrast was obtained for additional characterization of the lesions. There were 3 additional mixed signal lesions located within the left femoral neck and extending to the greater trochanter that enhanced with contrast. Because of the suspicion of malignancy, needle biopsy was performed. The pathologic findings in combination with the radiographic appearance confirmed the diagnosis of polyostotic fibrous dysplasia. CONCLUSION: This case demonstrated a rare aggressive appearance of polyostotic fibrous dysplasia located in the left innominate and the left proximal femur that prompted a diagnostic imaging workup and biopsy for suspected skeletal malignancy. These lesions may require careful evaluation by an experienced team of physicians, radiologists, and pathologists to ensure proper diagnosis and treatment.

Kienbock Disease: A Complicated Postsurgical Case Study Using Diagnostic Ultrasonography.

OBJECTIVE: The purpose of this case report is to describe a case of Kienbock disease (lunatomalacia) that was identified through diagnostic ultrasonography. CLINICAL FEATURES: A 27-year-old man presented to a chiropractic teaching clinic with a 3-year history of wrist pain. The history of chief concern consisted of lunatomalacia, diagnosed 2 years prior, with surgical intervention consisting of radial osteotomy and vascularized bone graft. Radiography and ultrasonography were performed upon presentation and at 2-year follow-up that demonstrated progressive collapse and fragmentation of his lunate with the development of progressive scapholunate advanced collapse of the wrist. INTERVENTION AND OUTCOME: Conservative care included class IV cold laser and a splint worn during strenuous activity and while sleeping. The patient received minimal pain relief and continued to experience chronic left wrist pain. He is continuing conservative care and evaluating options for further surgical intervention. CONCLUSION: This case demonstrates a patient with chronic wrist pain and progressive collapse of the lunate demonstrated on multiple imaging modalities after surgical intervention. To our knowledge, this is the first case demonstrating Kienbock disease using diagnostic ultrasonography.

Ultrasonography and radiography to identify early post traumatic myosistis ossificans in an 18-year-old male: a case report.

OBJECTIVE: The purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. CLINICAL FEATURES: An 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Follow-up radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. INTERVENTION AND OUTCOME: The patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. CONCLUSION: This case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course.

Giant Meckel diverticulum with enteroliths: a case report of a patient presenting with low back and episodic right lower quadrant pain.

OBJECTIVES: The purpose of this case report is to describe a patient who presented with low back pain and episodic right lower quadrant pain who had a long-standing giant Meckel diverticulum with enteroliths. CLINICAL FEATURES: A 49-year-old woman presented to a chiropractic clinic with low back pain and history of intermittent right lower quadrant pain. Lumbar radiography demonstrated calcifications in the pelvic basin that changed position with changes in patient posture. The patient was referred to an abdominal surgeon for consultation and management. INTERVENTION AND OUTCOME: Computed tomography identified calcifications in the small bowel in the region of the ileocecal valve. The patient underwent prophylactic diverticulectomy with no complications. Gross pathology revealed a giant Meckel diverticulum measuring 24 inches (60.9 cm) containing 6 enteroliths. CONCLUSIONS: A timely diagnosis resulted in a favorable surgical outcome for this patient with long-standing giant Meckel diverticulum and enteroliths.