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The Morel-Lavallee lesion: pathophysiology, clinical presentation, imaging features, and treatment options

Bonilla-Yoon, Iris; Masih, Sulabha; Patel, Dakshesh B; White, Eric A; Levine, Benjamin D; Chow, Kira; Gottsegen, Christopher J; Matcuk, George R Jr
Morel-Lavallee lesions are posttraumatic hemolymphatic collections related to shearing injury and disruption of interfascial planes between subcutaneous soft tissue and muscle. We review the pathophysiology of Morel-Lavallee lesions, clinical presentation, and potential sites of involvement. Magnetic resonance imaging (MRI) is the modality of choice for characterization. We present the MRI classification and highlight the key imaging features that distinguish the different types, focusing on the three most common: seroma, subacute hematoma, and chronic organizing hematoma. Potential mimics of Morel-Lavallee lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed.
PMID: 23949106
ISSN: 1070-3004
CID: 586882

Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management

White, Eric A; Patel, Dakshesh B; Matcuk, George R; Forrester, Deborah M; Lundquist, Ryan B; Hatch, George F Rick 3rd; Vangsness, C Thomas; Gottsegen, Christopher J
Injury to the ACL or PCL of the knee most commonly involves a tear of the collagenous fibers of the ligament. Less frequently, a cruciate ligament injury involves an avulsion fracture at the origin or insertion of the ligament, usually from the insertion site on the tibial surface. Avulsion fractures of the cruciate ligaments are important, as they can be identified on radiographs, allowing a specific diagnosis. Although more common in children, when they occur in adults, they are more commonly associated with other injuries. The treatment of cruciate ligament avulsion fractures is different than the treatment of intrasubstance tears of the cruciate ligaments. These injuries can be treated conservatively or surgically with good outcomes. Recently arthroscopic fixation of these injuries with various fixation devices has become more frequent. Treatment largely depends on the type of fracture, particularly, the size, displacement, comminution, and orientation of the avulsed fracture fragment, in addition to the integrity of the attached cruciate ligament. This review article covers the anatomy and biomechanics of the cruciate ligaments, their injury patterns, and approach to management.
PMID: 23525909
ISSN: 1070-3004
CID: 586862

Lipoma arborescens of the biceps tendon sheath

White, Eric A; Omid, Reza; Matcuk, George R; Domzalski, Jerome T; Fedenko, Alexander N; Gottsegen, Christopher J; Forrester, Deborah M; Patel, Dakshesh B
Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulting in a frond-like appearance, most frequently affects the suprapatellar recess of the knee. While there have been reports of this entity involving the upper extremity joints, bursa, and tendon sheaths, we present the first reported case of lipoma arborescens isolated to the biceps tendon sheath. We describe imaging and histologic findings with clinical correlation.
PMID: 23677483
ISSN: 0364-2348
CID: 586872

Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options

Earhart, Christina; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J; Forrester, Deborah M; Matcuk, George R Jr
Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed.
PMID: 22941569
ISSN: 1070-3004
CID: 586892

Giant cell tumor of bone: review, mimics, and new developments in treatment

Chakarun, Corey J; Forrester, Deborah M; Gottsegen, Christopher J; Patel, Dakshesh B; White, Eric A; Matcuk, George R Jr
Giant cell tumor (GCT) of bone is generally a benign tumor composed of mononuclear stromal cells and characteristic multinucleated giant cells that exhibit osteoclastic activity. It usually develops in long bones but can occur in unusual locations. The typical appearance is a lytic lesion with a well-defined but nonsclerotic margin that is eccentric in location, extends near the articular surface, and occurs in patients with closed physes. However, GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Fluid-fluid levels, consistent with secondary formation of aneurysmal bone cysts, are seen in 14% of cases. GCT can mimic or be mimicked by other benign or malignant lesions at both radiologic evaluation and histologic analysis. Rarely, GCT is associated with histologically benign lung metastases or undergoes malignant degeneration. In the past, the mainstay of treatment was surgical, primarily consisting of curettage with cement placement, with recurrence rates of 15%-25%. Recurrence is suggested by development of progressive lucency at the cement-bone interface. Other complications include pathologic fracture and postoperative infection. Denosumab, a monoclonal antibody that targets the osteoclastic activity of GCT, has produced 90% tumor necrosis in early studies, results indicative of promise as a potential adjuvant therapy.
PMID: 23322837
ISSN: 0271-5333
CID: 586902

Review of hemipelvectomy endoprostheses: Indications and imaging findings

White, E A; Learch, T J; Matcuk, G; Gottsegen, C; Menendez, L R; Ahlmann, E R; Moin, P; Szymanowski, J; Allison, D C; Patel, D B
EMBASE:2013358434
ISSN: 0160-9963
CID: 599732

Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee

Schein, Aaron; Matcuk, George; Patel, Dakshesh; Gottsegen, Christopher J; Hartshorn, Timothy; Forrester, Deborah; White, Eric
The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. There is a spectrum of injury severity, and injuries may be acute or chronic. The MCL is also frequently injured in conjunction with other knee structures. Clinical evaluation of the knee is important to assess the degree of surgical acuity, but magnetic resonance imaging can provide details about the injury that may not be obvious clinically. In addition to injury, MCL bursitis can occur and may be treated with needle aspiration and corticosteroid injection. This review article covers the anatomy and biomechanics of the MCL, its injury patterns and approach to management, and MCL bursitis.
PMID: 22890899
ISSN: 1070-3004
CID: 586912

Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications

Kim, Andrew C; Matcuk, George; Patel, Dakshesh; Itamura, John; Forrester, Deborah; White, Eric; Gottsegen, Christopher J
Shoulder injuries, including acromioclavicular (AC) joint separations, remain a common reason for presentation to the emergency room. Although the diagnosis can be made apparent through proper history and physical examination by the emergency medicine physician, ascertaining the degree of injury can be difficult on the basis of clinical evaluation alone. While there is consensus in the literature that low-grade AC joint injuries can be treated with conservative management, high-grade injuries will generally require surgical intervention. Furthermore, the treatment of grade 3 injuries remains controversial, making it incumbent upon the radiologist to become comfortable with distinguishing this diagnosis from lower or higher grade injuries. Imaging of AC joint injuries after clinical evaluation is generally initiated in the emergency room setting with plain film radiography; however, on occasion, an alternative modality may be presented to the emergency room radiologist for interpretation. As such, it remains important to be familiar with the appearance of AC joint separations on a variety of modalities. Another possible patient presentation in both the emergent and nonemergent setting includes new onset of pain or instability in the postsurgical shoulder. In this scenario, the onus is often placed on the radiologist to determine whether the pain or instability represents the sequelae of reinjury versus a complication of surgery. The purpose of this review is to present an anatomically based discussion of imaging findings associated with AC joint separations as seen on multiple modalities, as well as to describe and elucidate a variety of potential complications which may present to the emergency room radiologist.
PMID: 22639336
ISSN: 1070-3004
CID: 586922

Sclerosing bone dysplasias: review and differentiation from other causes of osteosclerosis

Ihde, Lauren L; Forrester, Deborah M; Gottsegen, Christopher J; Masih, Sulabha; Patel, Dakshesh B; Vachon, Linda A; White, Eric A; Matcuk, George R Jr
Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Hereditary sclerosing bone dysplasias result from some disturbance in the pathways involved in osteoblast or osteoclast regulation, leading to abnormal accumulation of bone. Several genes have been discovered that, when disrupted, result in specific types of hereditary sclerosing bone dysplasia (osteopetrosis, pyknodysostosis, osteopoikilosis, osteopathia striata, progressive diaphyseal dysplasia, hereditary multiple diaphyseal sclerosis, hyperostosis corticalis generalisata), many of which exhibit similar pathologic mechanisms involving endochondral or intramembranous ossification and some of which share similar underlying genetic defects. Nonhereditary dysplasias include intramedullary osteosclerosis, melorheostosis, and overlap syndromes, whereas acquired syndromes with increased bone density, which may simulate sclerosing bone dysplasias, include osteoblastic metastases, Paget disease of bone, Erdheim-Chester disease, myelofibrosis, and sickle cell disease. Knowledge of the radiologic appearances, distribution, and associated clinical findings of hereditary and nonhereditary sclerosing bone dysplasias and acquired syndromes with increased bone density is crucial for accurate diagnosis.
PMID: 22084176
ISSN: 0271-5333
CID: 586932

Gallery of uncommon orthopedic implants: a guide for emergency radiologist

White, Eric; Lu, Darren; Eyer, Ben; Gottsegen, Chris; Ahlmann, Elke; Allison, Chris
The purpose of this gallery of orthopedic implants was to provide a reference for emergency radiologists to quickly identify uncommon devices in the shoulders, hips, and extremities. The cases presented in this exhibit will include unusual arthroplasties and prostheses as well as bone graft implants (including allograft and autograft). Bone grafts are frequently used for the treatment of bone defects, which may be caused by trauma, infection, or avascularity. Autogenous cancellous, corticocancellous, or cortical bone grafts are often used, either free or vascularized. Alternative bone graft substitutes are also used. An obvious complication of bone grafts is the failure of incorporation. Joint arthroplasty is the most frequently performed orthopedic procedure after fracture fixation. Major indications include degenerative joint disease, inflammatory arthropathy, avascular necrosis, and complicated fractures. Custom orthopedic implants are frequently used for less common indications or for patients with bone tumors. The common hardware complications are infections, loosening, small particle disease/osteolysis, periprosthetic fracture, hardware fracture or dislocation, and recurrent disease, especially in patients with tumors. Many of the devices used by orthopedic surgeons are infrequently seen in everyday radiology practice. With such variations, correct recognition of the prosthetic devices and their complications is very important. The goal of this exhibit was to familiarize the radiologist with both the normal and abnormal appearance of many atypical orthopedic implants. It is important to understand the purpose and proper function of a device, but not necessarily important to describe every device by its proper brand name. Although this exhibit is not meant to be inclusive of every unusual orthopedic implant, we will present multiple examples of orthopedic hardware involving the shoulder, humerus, elbow, forearm, wrist, hand, pelvis, hip, femur, knee, tibia, ankle, and foot that are not likely seen in everyday practice.
PMID: 19859749
ISSN: 1070-3004
CID: 599702