Skeletal radiology
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The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. ⋯ Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in differentiating soft tissue from osseous impingement. Synovitic lesions in two control patients suggest that abnormal antero-lateral soft tissue does not necessarily imply the presence of symptomatic ALI. Synovitic lesions in excess of 10 mm were associated with symptoms. Ultrasound will not demonstrate osteocartilaginous lesions or stress fractures and may overlook some loose bodies. Ultrasound findings together with clinical correlation can be used to direct arthroscopic examination and surgical debridement.
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Comparative Study
Disc space-targeted angled axial MR images of the lumbar spine: a potential source of diagnostic error.
To compare the sensitivities of contiguous axial (CA) images and disc space-targeted angled axial (DSTAA) images of the lumbar spine for: (1) the detection of spondylolysis defects, and (2) the identification of disc material which has migrated away from the parent disc. ⋯ MR imaging of the lumbar spine using contiguous axial data obtained through both the level of the disc and vertebral body demonstrates migrated disc material and spondylolysis defects better than did disc space-targeted angled data.
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We report an unusual case of lumbosacral osteogenic sarcoma with cauda equina syndrome and invasion into the central venous and cardiac system. A 41-year-old Hispanic man presented to the emergency department complaining of severe low back pain, cauda equina syndrome, bilateral lower extremity edema, and an extra heart sound on physical examination. CT of the lumbosacral spine done in the emergency department demonstrated a sclerotic lesion in the sacrum with cortical destruction, extension into the spinal canal and a bulky soft tissue mass containing calcifications. ⋯ However, tumor extending into the central venous and cardiac system is rare. The previously reported cases of central venous and cardiac involvement have been related to distant metastases or primary cardiac osteosarcomas. There is only one other reported case of direct extension into the venous system by an iliac bone osteosarcoma in an adolescent; however, the tumor did not extend into the pulmonary circulation.