This document provides an overview of various conditions involving the foot and ankle that can be evaluated on radiology imaging. It discusses accessory ossicles that can occur in the foot and be a cause of pain. It also reviews conditions like rocker bottom foot, tarsal coalition, fractures around the ankle joint involving the lateral malleolus, tibial plafond, talus and calcaneus. Other topics covered include osteochondral defects of the talus, accessory ossicles of the foot, and angles used to evaluate calcaneal fractures.
This document provides an overview of MRI techniques and protocols for musculoskeletal imaging. It discusses common musculoskeletal injuries and conditions that can be identified on MRI, including meniscal tears, ligament tears, tendon injuries, osteochondral lesions, and bone marrow abnormalities. For each condition, it describes the MRI appearance and features that help characterize the severity and chronicity of the problem. Images are included to demonstrate the MRI findings for many common orthopedic pathologies.
This document provides information on MRI findings related to knee trauma. It describes common mechanisms of injury for the ACL, PCL, and menisci. It outlines primary and secondary MRI signs of ACL tears. It also details grading systems for ACL, meniscal, and chondromalacia injuries. Finally, it discusses characteristic bone bruise patterns associated with injuries like pivot shifts, dashboard impacts, hyperextensions, clips, and lateral patellar dislocations.
The document summarizes the radiological anatomy of the knee joint. It describes the various ligaments, tendons, bones and cartilage that make up the knee, including the medial and lateral menisci, anterior and posterior cruciate ligaments, patellar tendon, and surrounding muscles. It provides imaging protocols for MRI of the knee, covering positioning, slice thickness, pulse sequences and imaging planes used to visualize the different knee structures. Common anatomical variations and pitfalls in interpretation are also discussed.
about basics of cartilage imaging.
how does normal cartilage look , how does diseased cartilage look.
what are advanced techniques in cartilage imaging
MRI anatomy of ankle radiology ppt pk is nice presentation that covers cross sectional anatomy as well as relevant anatomy from standard radiology book like CT MRI whole body by Hagga . cross section of mri is taken from mrimaster.com. This will help for radiology resident as well radiographers.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
This document provides a summary of MRI findings related to the ankle and foot. It describes MRI sequences and images of various ankle structures including tendons, ligaments, bones and bursae. Specific pathologies are discussed such as tendinopathies, ligament tears, tenosynovitis, plantar fasciitis, sinus tarsi syndrome and tarsal tunnel syndrome. Images demonstrate normal anatomy as well as examples of injuries and conditions affecting the ankle and foot.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
This document provides an overview of MRI techniques and protocols for musculoskeletal imaging. It discusses common musculoskeletal injuries and conditions that can be identified on MRI, including meniscal tears, ligament tears, tendon injuries, osteochondral lesions, and bone marrow abnormalities. For each condition, it describes the MRI appearance and features that help characterize the severity and chronicity of the problem. Images are included to demonstrate the MRI findings for many common orthopedic pathologies.
This document provides information on MRI findings related to knee trauma. It describes common mechanisms of injury for the ACL, PCL, and menisci. It outlines primary and secondary MRI signs of ACL tears. It also details grading systems for ACL, meniscal, and chondromalacia injuries. Finally, it discusses characteristic bone bruise patterns associated with injuries like pivot shifts, dashboard impacts, hyperextensions, clips, and lateral patellar dislocations.
The document summarizes the radiological anatomy of the knee joint. It describes the various ligaments, tendons, bones and cartilage that make up the knee, including the medial and lateral menisci, anterior and posterior cruciate ligaments, patellar tendon, and surrounding muscles. It provides imaging protocols for MRI of the knee, covering positioning, slice thickness, pulse sequences and imaging planes used to visualize the different knee structures. Common anatomical variations and pitfalls in interpretation are also discussed.
about basics of cartilage imaging.
how does normal cartilage look , how does diseased cartilage look.
what are advanced techniques in cartilage imaging
MRI anatomy of ankle radiology ppt pk is nice presentation that covers cross sectional anatomy as well as relevant anatomy from standard radiology book like CT MRI whole body by Hagga . cross section of mri is taken from mrimaster.com. This will help for radiology resident as well radiographers.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
This document provides a summary of MRI findings related to the ankle and foot. It describes MRI sequences and images of various ankle structures including tendons, ligaments, bones and bursae. Specific pathologies are discussed such as tendinopathies, ligament tears, tenosynovitis, plantar fasciitis, sinus tarsi syndrome and tarsal tunnel syndrome. Images demonstrate normal anatomy as well as examples of injuries and conditions affecting the ankle and foot.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Here are the key points about rotator interval tears:
- The rotator interval is the space between the supraspinatus and subscapularis tendons through which the long head of the biceps tendon passes.
- Rotator interval tears refer to tears in the capsule in this space between the two tendons.
- They are often associated with instability or repetitive microtrauma and overuse.
- On MRI, they appear as abnormal high signal within the rotator interval capsule on fluid sensitive sequences like T2 or STIR. The torn edges may also enhance with contrast.
- Ultrasound can also identify fluid within the torn interval capsule but MRI is usually better for full
1. MRI utilizes the magnetic spin property of protons in hydrogen atoms to produce images.
2. Different pulse sequences such as T1-weighted, T2-weighted, and proton density weighted images provide varying contrast between tissues based on relaxation times.
3. Evaluation of MRI involves determining the optimal pulse sequence, analyzing images for abnormalities, and correlating findings with clinical information.
Presentation1.pptx, ultrasound of the hand and fingers.Abdellah Nazeer
This document provides guidance on performing ultrasound examination of the hand and fingers. It describes optimal scanning techniques and positioning for visualizing key anatomical structures like flexor and extensor tendons, pulleys, ligaments and joints. Pathologies that can be identified include tendinosis, tenosynovitis, trigger finger, Dupuytren's contracture and inflammatory arthritis. Ultrasound allows accurate assessment of tendon integrity, fluid collections, synovitis and Doppler flow to evaluate degree of inflammation.
This document provides an overview of MRI techniques for imaging the elbow joint and describes various normal and pathological findings. Key points include:
1. MRI is useful for evaluating bone marrow edema, ligament and tendon injuries, cartilage defects, bursitis, and nerve entrapment around the elbow joint.
2. Common elbow injuries discussed include ulnar collateral ligament tears, lateral epicondylitis, osteochondritis dissecans, and triceps tendon avulsions.
3. Elbow arthropathies such as rheumatoid arthritis, osteoarthritis, and loose bodies can also be identified on MRI.
This document provides an overview of MRI techniques for evaluating the shoulder joint and common shoulder pathologies. It begins with normal shoulder anatomy as seen on MRI and descriptions of impingement syndrome, rotator cuff tears, labral tears, instability, biceps tendon injuries, and other conditions. For each pathology, the document describes MRI appearance and features that should be included in reports. In summary, the document is a guide for radiologists to understand MRI of the shoulder and identify and characterize various shoulder injuries and diseases.
This document provides information on bone tumors, including their classification, locations, and radiographic features. It discusses benign bone forming tumors like bone islands and osteoblastomas. It also covers cartilage forming tumors such as enchondromas and osteochondromas, as well as fibrous lesions including fibrous dysplasia. Malignant tumors described include osteosarcoma, chondrosarcoma, and malignant fibrous histiocytoma. For each tumor type, the document provides details on incidence, anatomical distribution, and characteristic imaging appearance to aid in diagnosis.
Presentation1.pptx. imaging of the cartilage.Abdellah Nazeer
1. Imaging modalities such as radiography, ultrasound, CT arthrography, and MRI are used to evaluate articular cartilage and subchondral bone. MRI is the preferred method as it can detect early cartilage degeneration without radiation exposure.
2. Cartilage damage is graded on MRI from Grade I (mild increased signal) to Grade IV (full thickness defects). Subchondral bone changes like edema, fractures, and osteophytes also provide information about the severity and cause of injury or disease.
3. Techniques like dGEMRIC and T1ρ mapping can detect early biochemical changes in cartilage like glycosaminoglycan loss prior to macroscopic defects, helping evaluate and monitor treatments.
Presentation1, radiological imaging of anterior knee pain.Abdellah Nazeer
This document discusses radiological imaging of anterior knee pain. It notes that knee MRI is the gold standard for evaluating damage to anatomical structures like ligaments, tendons, meniscus and cartilage. Common causes of anterior knee pain discussed include patellar fractures, osteoarthritis, tendinitis, dislocations and cartilage defects. Specific conditions like osteochondritis dissecans, fat pad syndromes, and bipartite/multipartite patella are described. MRI features of various pathologies are shown through images to aid radiologists in diagnosis.
This document provides an overview of various radiographic views and techniques used to image the foot and ankle. It describes standard ankle x-rays such as AP, mortise, and lateral views. It also discusses stress views used to evaluate ankle instability. Other imaging modalities such as CT, ultrasound, MRI, bone scanning are summarized. Common foot and ankle pathologies and how they appear on different tests are outlined. The purpose is to serve as a reference for foot and ankle imaging evaluations.
The ankle joint is formed by the tibia, fibula, and talus. It is supported by the lateral and medial collateral ligaments. The distal tibiofibular joint is a fibrous joint supported by syndesmotic ligaments. MRI is useful for evaluating the tendons, ligaments, bones, and cartilage of the ankle. It can detect injuries, infections, tendonitis, and other pathologies. While MRI can depict the soft tissues of the ankle well, it may be difficult to precisely identify individual ligament bands. However, MRI provides excellent sensitivity to detect partial tears, fluid, and bone marrow edema that can indicate ankle pathology.
This document discusses MR imaging of the knee. It describes common knee pathologies like meniscal tears, ligament injuries, and cartilage lesions. It provides details on MR imaging techniques and protocols for the knee. Specific meniscal anatomy and grading of meniscal signal are reviewed. Various types of meniscal tears, ligament injuries like ACL and PCL tears are demonstrated with images. Other findings like cartilage lesions, bony lesions, tendon injuries are also described. Potential pitfalls in interpreting MR images of the knee like pseudo meniscal tears are discussed to improve diagnostic accuracy.
This document provides an overview of MRI indications and findings for wrist pathology. It lists common indications for MRI such as wrist instability, pain, trauma, necrosis, and limited range of motion. It then reviews MRI sequences, wrist anatomy, and various wrist conditions that may be seen on MRI such as fractures, ligament tears, instability patterns, tenosynovitis, ganglion cysts, tumors and other soft tissue lesions.
This document provides an overview of ankle radiography including:
- The Ottawa Ankle Rules for determining when radiographs are needed
- Common radiographic projections of the ankle including AP, mortise, and lateral views
- Measurements taken from the different views to assess for fractures and ligament injuries
- Stress tests that can be performed under fluoroscopy to evaluate ligament integrity
- Classification systems for common ankle fractures like the Danis-Weber and Pott's classifications
74-Dr Ahmed Esawy imaging oral board MRI ankle & foot part IAHMED ESAWY
The document discusses the history and importance of chocolate in human civilization. It notes that chocolate originated in Mesoamerica over 3000 years ago and was prized by the Aztecs and Mayans for its taste. Cocoa beans were used as currency and their cultivation was tightly regulated. The document highlights how chocolate spread around the world following the age of exploration and is now one of the most popular flavors worldwide.
This document provides an overview of shoulder anatomy and MRI of the shoulder. It describes the bony anatomy including the coracoid process and spine of the scapula. It discusses the stabilizers of the shoulder joint including muscles like the rotator cuff as well as ligaments. The document then focuses on the rotator cuff muscles - supraspinatus, infraspinatus, teres minor and subscapularis. It provides details on their origins, insertions and actions. The document also discusses MRI techniques for the shoulder and presentations of common shoulder pathologies like rotator cuff tears and adhesive capsulitis on MRI.
This document provides information on femoroacetabular impingement (FAI) and its open surgical treatment. It defines FAI as abnormal hip morphology causing repeated contact between the proximal femur and acetabulum during motion. This can eventually lead to osteoarthritis. It describes the three main types of FAI - cam, pincer, and mixed - and explains their causes, mechanisms, and associated articular damage patterns. The document outlines the physical exam and imaging findings for FAI and discusses arthroscopic versus open surgical treatment options. It provides details on the open surgical technique of safe hip dislocation, including the osteotomy, exposure, visualization, and steps to address acetabular and femoral abnormalities.
The document discusses femoral neck fractures, including:
- Anatomy of the hip joint and blood supply of the femoral neck
- Mechanisms of injury including low-energy falls in the elderly
- Classification systems including Garden and Pauwel classifications
- Clinical features such as pain on hip motion and inability to perform straight leg raises
- Diagnosis using x-rays and other imaging modalities like CT and MRI
- Treatment goals of minimizing discomfort, restoring function, and obtaining early anatomic reduction and stable fixation
Here are the key points about rotator interval tears:
- The rotator interval is the space between the supraspinatus and subscapularis tendons through which the long head of the biceps tendon passes.
- Rotator interval tears refer to tears in the capsule in this space between the two tendons.
- They are often associated with instability or repetitive microtrauma and overuse.
- On MRI, they appear as abnormal high signal within the rotator interval capsule on fluid sensitive sequences like T2 or STIR. The torn edges may also enhance with contrast.
- Ultrasound can also identify fluid within the torn interval capsule but MRI is usually better for full
1. MRI utilizes the magnetic spin property of protons in hydrogen atoms to produce images.
2. Different pulse sequences such as T1-weighted, T2-weighted, and proton density weighted images provide varying contrast between tissues based on relaxation times.
3. Evaluation of MRI involves determining the optimal pulse sequence, analyzing images for abnormalities, and correlating findings with clinical information.
Presentation1.pptx, ultrasound of the hand and fingers.Abdellah Nazeer
This document provides guidance on performing ultrasound examination of the hand and fingers. It describes optimal scanning techniques and positioning for visualizing key anatomical structures like flexor and extensor tendons, pulleys, ligaments and joints. Pathologies that can be identified include tendinosis, tenosynovitis, trigger finger, Dupuytren's contracture and inflammatory arthritis. Ultrasound allows accurate assessment of tendon integrity, fluid collections, synovitis and Doppler flow to evaluate degree of inflammation.
This document provides an overview of MRI techniques for imaging the elbow joint and describes various normal and pathological findings. Key points include:
1. MRI is useful for evaluating bone marrow edema, ligament and tendon injuries, cartilage defects, bursitis, and nerve entrapment around the elbow joint.
2. Common elbow injuries discussed include ulnar collateral ligament tears, lateral epicondylitis, osteochondritis dissecans, and triceps tendon avulsions.
3. Elbow arthropathies such as rheumatoid arthritis, osteoarthritis, and loose bodies can also be identified on MRI.
This document provides an overview of MRI techniques for evaluating the shoulder joint and common shoulder pathologies. It begins with normal shoulder anatomy as seen on MRI and descriptions of impingement syndrome, rotator cuff tears, labral tears, instability, biceps tendon injuries, and other conditions. For each pathology, the document describes MRI appearance and features that should be included in reports. In summary, the document is a guide for radiologists to understand MRI of the shoulder and identify and characterize various shoulder injuries and diseases.
This document provides information on bone tumors, including their classification, locations, and radiographic features. It discusses benign bone forming tumors like bone islands and osteoblastomas. It also covers cartilage forming tumors such as enchondromas and osteochondromas, as well as fibrous lesions including fibrous dysplasia. Malignant tumors described include osteosarcoma, chondrosarcoma, and malignant fibrous histiocytoma. For each tumor type, the document provides details on incidence, anatomical distribution, and characteristic imaging appearance to aid in diagnosis.
Presentation1.pptx. imaging of the cartilage.Abdellah Nazeer
1. Imaging modalities such as radiography, ultrasound, CT arthrography, and MRI are used to evaluate articular cartilage and subchondral bone. MRI is the preferred method as it can detect early cartilage degeneration without radiation exposure.
2. Cartilage damage is graded on MRI from Grade I (mild increased signal) to Grade IV (full thickness defects). Subchondral bone changes like edema, fractures, and osteophytes also provide information about the severity and cause of injury or disease.
3. Techniques like dGEMRIC and T1ρ mapping can detect early biochemical changes in cartilage like glycosaminoglycan loss prior to macroscopic defects, helping evaluate and monitor treatments.
Presentation1, radiological imaging of anterior knee pain.Abdellah Nazeer
This document discusses radiological imaging of anterior knee pain. It notes that knee MRI is the gold standard for evaluating damage to anatomical structures like ligaments, tendons, meniscus and cartilage. Common causes of anterior knee pain discussed include patellar fractures, osteoarthritis, tendinitis, dislocations and cartilage defects. Specific conditions like osteochondritis dissecans, fat pad syndromes, and bipartite/multipartite patella are described. MRI features of various pathologies are shown through images to aid radiologists in diagnosis.
This document provides an overview of various radiographic views and techniques used to image the foot and ankle. It describes standard ankle x-rays such as AP, mortise, and lateral views. It also discusses stress views used to evaluate ankle instability. Other imaging modalities such as CT, ultrasound, MRI, bone scanning are summarized. Common foot and ankle pathologies and how they appear on different tests are outlined. The purpose is to serve as a reference for foot and ankle imaging evaluations.
The ankle joint is formed by the tibia, fibula, and talus. It is supported by the lateral and medial collateral ligaments. The distal tibiofibular joint is a fibrous joint supported by syndesmotic ligaments. MRI is useful for evaluating the tendons, ligaments, bones, and cartilage of the ankle. It can detect injuries, infections, tendonitis, and other pathologies. While MRI can depict the soft tissues of the ankle well, it may be difficult to precisely identify individual ligament bands. However, MRI provides excellent sensitivity to detect partial tears, fluid, and bone marrow edema that can indicate ankle pathology.
This document discusses MR imaging of the knee. It describes common knee pathologies like meniscal tears, ligament injuries, and cartilage lesions. It provides details on MR imaging techniques and protocols for the knee. Specific meniscal anatomy and grading of meniscal signal are reviewed. Various types of meniscal tears, ligament injuries like ACL and PCL tears are demonstrated with images. Other findings like cartilage lesions, bony lesions, tendon injuries are also described. Potential pitfalls in interpreting MR images of the knee like pseudo meniscal tears are discussed to improve diagnostic accuracy.
This document provides an overview of MRI indications and findings for wrist pathology. It lists common indications for MRI such as wrist instability, pain, trauma, necrosis, and limited range of motion. It then reviews MRI sequences, wrist anatomy, and various wrist conditions that may be seen on MRI such as fractures, ligament tears, instability patterns, tenosynovitis, ganglion cysts, tumors and other soft tissue lesions.
This document provides an overview of ankle radiography including:
- The Ottawa Ankle Rules for determining when radiographs are needed
- Common radiographic projections of the ankle including AP, mortise, and lateral views
- Measurements taken from the different views to assess for fractures and ligament injuries
- Stress tests that can be performed under fluoroscopy to evaluate ligament integrity
- Classification systems for common ankle fractures like the Danis-Weber and Pott's classifications
74-Dr Ahmed Esawy imaging oral board MRI ankle & foot part IAHMED ESAWY
The document discusses the history and importance of chocolate in human civilization. It notes that chocolate originated in Mesoamerica over 3000 years ago and was prized by the Aztecs and Mayans for its taste. Cocoa beans were used as currency and their cultivation was tightly regulated. The document highlights how chocolate spread around the world following the age of exploration and is now one of the most popular flavors worldwide.
This document provides an overview of shoulder anatomy and MRI of the shoulder. It describes the bony anatomy including the coracoid process and spine of the scapula. It discusses the stabilizers of the shoulder joint including muscles like the rotator cuff as well as ligaments. The document then focuses on the rotator cuff muscles - supraspinatus, infraspinatus, teres minor and subscapularis. It provides details on their origins, insertions and actions. The document also discusses MRI techniques for the shoulder and presentations of common shoulder pathologies like rotator cuff tears and adhesive capsulitis on MRI.
This document provides information on femoroacetabular impingement (FAI) and its open surgical treatment. It defines FAI as abnormal hip morphology causing repeated contact between the proximal femur and acetabulum during motion. This can eventually lead to osteoarthritis. It describes the three main types of FAI - cam, pincer, and mixed - and explains their causes, mechanisms, and associated articular damage patterns. The document outlines the physical exam and imaging findings for FAI and discusses arthroscopic versus open surgical treatment options. It provides details on the open surgical technique of safe hip dislocation, including the osteotomy, exposure, visualization, and steps to address acetabular and femoral abnormalities.
The document discusses femoral neck fractures, including:
- Anatomy of the hip joint and blood supply of the femoral neck
- Mechanisms of injury including low-energy falls in the elderly
- Classification systems including Garden and Pauwel classifications
- Clinical features such as pain on hip motion and inability to perform straight leg raises
- Diagnosis using x-rays and other imaging modalities like CT and MRI
- Treatment goals of minimizing discomfort, restoring function, and obtaining early anatomic reduction and stable fixation
This document contains medical images and descriptions of various musculoskeletal signs and pathologies. It discusses imaging findings and classifications for conditions like:
- Adhesive capsulitis showing thickened ligaments.
- SLAC and SNAC wrist classifications.
- Femoroacetabular impingement presentations.
- Charcot neuroarthropathy acute and chronic stages.
- Various tendon injuries and ligamentous injuries patterns.
It provides comparisons of imaging findings between similar conditions like fibrous dysplasia and osteofibrous dysplasia. Assessment techniques for foot deformities like clubfoot and flatfoot are also outlined.
This document provides an overview of radiological examination of fractures and traumatic injuries. It discusses how radiology can be used to assess fracture type, location, complications, and associated soft tissue injuries. Specific fractures and injuries of the skull, spine, pelvis, hip, knee, ankle, shoulder and forearm are examined. Radiological signs of non-accidental injuries in children are also reviewed. The document emphasizes the importance of radiology in the diagnosis and management of skeletal trauma.
The document discusses fractures of the talus bone. It provides a brief history of studies on talus injuries from 1919 to 1970. It then describes the anatomy of the talus bone and its limited blood supply. Different classification systems for talus fractures are mentioned. Treatment depends on fracture type but generally involves closed or open reduction and internal fixation to restore alignment and blood flow. Complications like osteonecrosis can occur depending on displacement and are challenging to treat.
Appendicular trauma refers to injuries or damage sustained to the appendicular skeleton, which includes the bones of the upper and lower extremities (arms and legs) as well as the pelvis. These injuries can result from various causes such as accidents, falls, sports-related incidents, or direct blows.
This document provides an overview of ankle and foot anatomy, imaging, and common injuries. It describes:
1) The bones and joints of the ankle and foot, including the tibiotalar, subtalar, and tarsometatarsal joints.
2) Common ankle and foot injuries like fractures of the distal tibia and fibula, talus, and calcaneus. As well as ligament tears and dislocations.
3) Imaging techniques used to evaluate the ankle and foot, including standard radiographs, stress views, and arthrography. Key anatomical angles and measurements are also outlined.
The document discusses diagnostic radiology of musculoskeletal system fractures and tumor-like lesions. It begins by defining fractures and describing their classification, location, alignment, healing process and complications. It then discusses specific fracture types like Colles fractures, supracondylar fractures, compression fractures and burst fractures. Finally, it covers tumor-like lesions such as osteosarcoma, describing their presentation, location and radiographic findings.
This document describes various fractures of the lower limbs, including: femur (femoral neck, shaft, distal end), tibia and fibula, patella, ankle (Weber classification), calcaneus (Sanders classification), and metatarsals. Key details are provided on classifications of femoral neck fractures (Garden, Pauwels), tibial plateau fractures, and calcaneal fractures. Common fracture patterns such as supracondylar femoral fractures and lateral malleolar fractures are also outlined.
The document discusses anterior dislocation of the hip and fractures of the femoral neck. Anterior dislocation of the hip is rare and usually caused by trauma, with two types described. Fractures of the femoral neck are most common in the elderly and can be classified using Garden's system. Surgical treatment including internal fixation or hip replacement is usually needed for displaced fractures to prevent complications like avascular necrosis.
Compartment syndrome most commonly occurs in the anterior compartment of the leg. The anterior compartment contains the muscles that lift the toes and extend the foot. It has relatively inelastic fascial boundaries that can easily become tense and compressed when swelling occurs within the compartment due to trauma, such as a fracture. The small and tight space makes the anterior leg muscles particularly vulnerable to pressure buildup and the decreased blood flow that can develop into compartment syndrome.
The document discusses lower limb fractures and dislocations, including the femur neck, intertrochanteric region, hip joint, femoral shaft, distal femur, knee joint, patella, tibial plateau, tibial shaft, malleoli, talus, and calcaneum. For each injury, the document outlines mechanisms of injury, clinical presentation, classification systems, radiological findings, complications, and treatment options. Conservative treatments include casting or traction, while operative options involve fixation devices like plates, screws, nails, or reconstruction as needed to stabilize fractures and restore joint alignment.
This document summarizes common lower limb fractures, including fractures of the femur (hip), tibia, fibula, patella, ankle, calcaneus, and metatarsals. It describes the location and classification of these fractures, along with examples of X-ray images demonstrating various fracture patterns such as femoral neck, tibial plateau, lateral malleolus, and Jones fractures of the 5th metatarsal. Classification systems are outlined for femoral neck, ankle, and calcaneal fractures based on their location and degree of displacement.
The document discusses ankle fractures, providing information on ankle anatomy, classification systems, clinical features, imaging, treatment, and complications. It describes the ankle joint as composed of the tibia, fibula, and talus bones. Two common classification systems are described - the Weber system categorizes fractures by the location of the fibular fracture in relation to the syndesmosis, while the Lauge-Hansen system depends on the mechanism of injury. Clinical features may include pain, swelling, limited movement, and neurovascular issues. Imaging includes x-rays and sometimes CT or MRI to evaluate bone and soft tissue injuries. Treatment involves initial stabilization followed by casting or surgery to restore anatomy, with goals of preventing post-traumatic arthritis
The document discusses ankle injuries, anatomy, and classifications. It describes the Lauge-Hansen classification system which categorizes injuries by bending and twisting forces. Injuries include fractures of the medial and lateral malleoli as well as ligament ruptures. Treatment involves restoring the ankle mortise either through conservative methods like casting or surgical fixation of fractures. The goal is anatomical reduction to allow joint motion and prevent osteoarthritis.
Plain film x-rays are useful for initially evaluating spinal trauma and detecting abnormalities like fractures and disc space narrowing. CT scans are better for detecting spinal fractures and bone fragments in the spinal canal. MRI is the best imaging technique for evaluating the spinal cord, nerves, soft tissues, and detecting conditions like disc herniations, spinal tumors, and spinal cord injuries. It can also detect bone marrow abnormalities and is the most accurate test for multiple myeloma, metastases and infections affecting the spine.
Femur fracture and it management and casesonkosurgery
This document discusses various types of femoral fractures including: femoral head fractures, femoral neck fractures, intertrochanteric fractures, subtrochanteric fractures, and distal femur fractures. It provides details on mechanisms of injury, clinical presentation, imaging, classification systems, and treatment approaches for each type of femoral fracture. Nonoperative and operative treatment options are described depending on the fracture pattern and patient factors.
This document discusses various types of femoral fractures including: femoral head fractures, femoral neck fractures, intertrochanteric fractures, subtrochanteric fractures, and distal femur fractures. It provides details on mechanisms of injury, clinical presentation, imaging, classification systems, and treatment approaches for each type of femoral fracture. Nonoperative and operative treatment options are described depending on the fracture pattern and patient factors.
This document discusses cerebrovascular malformations (CVMs) of the brain. It describes that CVMs are disorders representing morphogenetic errors affecting brain arteries, capillaries or veins. It classifies CVMs into two main groups - vascular malformations and hemangiomas. Pial arteriovenous malformations (AVMs) are specifically discussed. Pial AVMs have direct connections between arteries and veins without an intervening capillary bed. They contain enlarged feeding arteries, a nidus of tangled vascular channels, and dilated draining veins. Imaging findings on CT, MRI and cerebral angiography are provided to identify the key components of pial AVMs. Differential diagnoses and clinical management are also reviewed.
Peliosis hepatis is a rare benign liver condition characterized by multiple blood-filled cyst-like spaces within the liver parenchyma. It can be asymptomatic but sometimes presents with abdominal discomfort, hepatomegaly, or hemorrhage. The condition has various etiologies including drug use, infections, and malignancies. Imaging findings on ultrasound, CT, and MRI can include hypoechoic or hypodense lesions that demonstrate early enhancement on arterial phase and incomplete washout on venous phase. Histopathological examination of biopsied lesions typically shows dilated sinusoids filled with blood and bounded by liver cell cords.
This document discusses Mycobacterium tuberculosis and central nervous system tuberculosis, focusing on intracranial tuberculomas. It describes the etiology, clinical features, imaging appearance and characteristics of tuberculomas on CT and MRI. Tuberculomas appear as ring-enhancing lesions on imaging and can be distinguished from other ring-enhancing lesions like abscesses, metastases and neurocysticercosis based on their imaging characteristics and presence of a caseous necrotic core. Differential diagnosis and pathology of tuberculomas are also discussed.
This document discusses various benign bone tumors. It begins by defining a neoplasm and classifying tumors as benign, potentially malignant, or malignant. It then discusses the epidemiology and classification of benign bone tumors. Specific benign bone tumors discussed in detail include bone island, osteoma, osteoid osteoma, osteoblastoma, chondroma, chondroblastoma, and chondromyxoid fibroma. For each tumor, the document outlines characteristics such as typical age, location, radiographic appearance, and distinguishing features.
Dural venous sinus thrombosis for Radiology & Imagingmacshrestha
The document discusses dural venous sinus thrombosis, noting that it occurs when blood clots form in the dural venous sinuses which drain blood from the brain. It can be caused by factors like oral contraceptive use, pregnancy, genetic conditions or infections. Symptoms include headaches, nausea, seizures and vision changes, and imaging with CT, CT venography or MRI is used to identify clots within the dural venous sinuses.
Empyema necessitans is a rare complication of empyema thoracis where the pleural infection extends out of the thorax into the chest wall or surrounding soft tissues. It can be caused by various organisms such as mycobacteria, actinomyces, or fungi. Patients may present with chest pain, erythema, swelling over the chest wall, and symptoms of pulmonary infection. Imaging such as chest X-ray, CT, or MRI can show fluid densities extending into subcutaneous tissues from the pleural space. Treatment involves surgical drainage of abscesses followed by cultures to identify the causative organism and administer appropriate antibiotics.
This document discusses two types of soft tissue sarcomas: mesenchymal chondrosarcoma and synovial sarcoma. Both tumor types contain soft tissue components, calcified areas, mineralization, and cystic areas or necrosis/hemorrhage. Mesenchymal chondrosarcoma has a bimodal age distribution in the 3rd and 5th decades, while synovial sarcoma typically presents between 15-50 years of age, with a mean of 35 years. The tumors can arise in soft tissues near joints. Imaging findings include soft tissue masses with mineralization or calcification that demonstrate enhancement. Histopathological examination is needed for definitive diagnosis of each tumor type.
This document discusses head trauma and various types of brain injuries seen on CT imaging. It provides details on:
1) Classification of head injuries as mild, moderate or severe based on Glasgow Coma Scale. It also describes primary injuries that occur at the time of trauma versus secondary injuries that develop later.
2) Common primary brain injuries seen on CT such as epidural hematomas, subdural hematomas, skull fractures, cerebral contusions, and diffuse axonal injury.
3) Guidelines for use of head CT in traumatic brain injury patients based on American College of Radiology criteria, New Orleans Criteria, and Canadian Head CT Rule.
4) Features of various types of skull fractures,
Brain abscesses typically present as rim-enhancing lesions that evolve through four stages: early and late cerebritis, early capsule formation, and late capsule. Imaging plays a key role in diagnosis, with CT showing a hypodense lesion and MRI demonstrating a central hyperintense region on T2-weighted imaging surrounded by a hypointense rim. Treatment involves surgical drainage and long-term antibiotics, while complications may arise if left untreated such as meningitis, daughter lesions, or mass effect on brain structures. Differential diagnoses include tumors, demyelinating diseases, and infarcts.
Choledochal cyst is a congenital anomaly involving cystic dilation of the bile ducts. It is classified into 5 types based on the location and extent of dilation. Type I is the most common. Imaging plays an important role in diagnosis and classification, with MRCP being the gold standard. Treatment involves complete excision of the cyst and Roux-en-Y hepaticojejunostomy. Complications include stones, malignancy, cholangitis and rupture. Caroli's disease is a rare disorder involving saccular dilation of intrahepatic bile ducts.
Metastases are tumor implants discontinuous from the primary tumor. Pulmonary metastases most commonly present as multiple pulmonary nodules and are usually bilateral with a basal predominance. They most often spread to the lungs via the bloodstream. The lungs act as a filter for the blood, allowing cancer cells from primary tumors in many sites like breast, bone, and urogenital organs to become lodged in the lungs. Radiologically, metastases typically appear as rounded nodules but can also cavitate, calcify, or cause consolidations. Diagnosis involves determining the primary site through clinical evaluation, imaging, and biopsy of lesions. Treatment options include chemotherapy, radiation, surgery, and palliative care.
Simple bone cysts, also known as unicameral bone cysts, are benign bone lesions of unknown cause that typically occur in the metaphysis of long bones like the proximal humerus and femur in children and adolescents. They appear on x-ray as areas of translucency in the bone and often cause pain, swelling or pathological fractures. Treatment involves curettage and bone grafting if the risk of fracture is high or steroid injections if the cyst is small with a low fracture risk.
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
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Endocrine Therapy
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Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
2. Contents
Accessory ossicles of the foot
Rocker bottom foot
Tarsal coalition
Fractures around the ankle
Plantar fascia
Brodie’s abscess in distal tibia
Soft tissue masses around ankle
Retrocalcaneal bursitis
Haglund syndrome
Achilles tendinopathy
Achilles tendon tears
3. Accessory ossicles of the foot
are secondary ossification centers that are separate from
the adjacent bone
Usually round or ovoid
have well defined smooth cortical margins on all sides.
Clinical importance
May fracture
Can cause pain
May be involved in rheumatoid arthritis, osteoarthritis, infections
& hyperparathyroidism
4. Accessory ossicles of the foot
Os tibiale externum
Os trigonum
Os peroneum
Os vesalianum
Os subtibiale
Os subfibulare
Os supratalare
Os cancaneus secundarius
5. Os tibiale externum
Also called accessory navicular
is present adjacent to the medial side of navicular
Can cause painful tendinosis of tibialis posterior
tendon
Imaging
best visualized on the lateral-oblique view
may appear as a 'hot spot' on bone scan
on MRI, bone marrow oedema can be seen
8. Os peroneum
Commonly found – 8%
located at the lateral plantar aspect of the cuboid
within the substance of the peroneus longus tendon
D/D
Os vesalianum
Apophysis of the 5th metatarsal
Avulsion fracture
12. Os vesalianum
situated at the base of the fifth metatarsal in the
peroneus brevis tendon
Less common than os peroneum
D/D
Os peroneum
Apophysis of 5th metatarsal – in children
Avulsion fracture
14. Os trigonum
sits posterior to the talus on the lateral foot radiograph
Incidence – about 7% of population
15. Less common accessory ossicles
Os subtibiale
related to the posterior colliculus of the medial malleolus
Os subfibulare
lies at the tip of the lateral malleolus
Os supratalare
located at the superior aspect of the talar head or neck
Os cancaneus secundarius
Located at anterior calcaneal process
17. Rocker bottom foot/ congenital vertical talus
Congenital anomaly
Characterized by prominent heel/ calcaneus & a convex
rounded sole
results from dorsal and lateral dislocation of the
talonavicular joint.
Foot resembles bottom of a rocking chair
In adult, it can occur secondary to
Neuromuscular disorder
Diabetic foot (charcot joint)
18. Imaging findings
fixed equinus: plantarflexion of the calcaneus
vertical talus: plantarflexion of the talus
irreducible dorsal subluxation or dislocation of the
navicular
forefoot valgus: divergence of bases of the metatarsal heads
on AP and superimposition of the metatarsal bones on the
lateral view
long axis of the talus passes plantar to metatarsal axis on
lateral view and medial to the first metatarsal on AP view
19. Rocker bottom foot
AP view shows calcaneus valgus
& metatarsal valgus. The long
axis of talus is much medial to
st
On lateral view, there is equinus of the
calcaneus and vertical orientation of talus.
Navicular has not yet ossified
21. Tarsal coalition
complete or partial union between two or more bones
in the midfoot & hindfoot
Incidence – about 5 % of population
Patient usually present in adolescence
refers to developmental fusion rather than fusion that
is acquired secondary to conditions such
as rheumatoid arthritis, trauma or post-surgical.
22. Types
They may be of 3 types, depending on the tissue which
bridges between the two bones. The three types are 1:
I. bony: synostosis
II. cartilaginous: synchondrosis
III. fibrous: syndesmosis
26. Talocalcaneal coalition
Although all three facets of the talocalcaneal joint can be
involved, the middle facet is most commonly involved.
Often requires cross-sectional imaging for accurate diagnosis
Plain radiograph
C-sign(lateral film) – posterior continuity of talus & sustentaculum
tali
Talar beak sign (latearal film) – prominent beak at the anterior end
of talus
non-visualisation of the middle articular facet
Sclerosis around the articular margins of the talocalcaneal joint
CT – coronal reformats are best
MRI
27. C sign in Talocalcaneal coalition
Red: talus; blue: sustentaculum tali - blue line is continuous between the talus
and sustentaculum tali demonstrating coalition.
29. Fractures around the ankle
Lateral malleolus fracture
Fracture through the Tibial plafond
Talus fracture
Calcaneus fracture
30. Lateral malleolus fracture
commonly the result of twisting injury of the talus in
ankle mortise.
Radiographs are usually sufficient for the management
of what are typically simple fractures.
CT axial images through both ankles are useful when
the integrity of the syndesmosis is questioned.
“Weber” staging system for ankle fractures – to
understand mechanism of syndesmotic injury.
syndesmotic injuries usually require screw fixation
31. Weber classification of lateral malleolar fractures
Type A
Below talar dome
Usually transverse
Syndesmosis intact
Deltoid ligament intact
Type B
distal extent at the level of the talar dome
Usually spiral
syndesmosis usually intact, but widening of the distal tibiofibular joint
(especially on stressed views) indicates syndesmotic injury
deltoid ligament may be torn, indicated by widening of the space between
the medial malleolus and talar dome
Type C
above the level of the ankle joint
tibiofibular syndesmosis disruption with widening of the distal tibiofibular
articulation
medial malleolus fracture or deltoid ligament injury often present
35. Weber B
There is oblique fracture of distal fibula.
fracture extends distally to the level of the ankle joint.
There is no significant widening of the tibiofibular joint to suggest syndesmosis tear.
38. Fracture through the Tibial plafond
In adult –
Pilon fracture
In adolescents
Tillaux fracture
Triplane fracture
39. Pilon Fracture
any tibial fracture that involves the distal articular
plafond and are typically the result of an axial loading
force
can produce significant comminution with multiple
displaced fracture fragments
X-ray & CT
fractures lines are seen extending into the tibiotalar
articular surface
40. Pilon fracture
28 yrs. after Road
Traffic Accident
There is a comminuted
distal tibial fracture
extending into
the tibial plafond
41. Juvenile Tillaux fracture
Salter-Harris type 3 fracture
Have characteristic appearance on CT
Mechanism - an external rotation force pulling on the
anterior tibiofibular ligament, causing avulsion of the
anterolateral corner of the distal tibial epiphysis with
variable amount of displacement
Why always laterally?
because the distal tibial physis fuses from medial to lateral as
a child matures
Age
Adolescents in whom, lateral growth plate has not fused
12-15 years
42. Tillaux fracture – 15 years male
Tillaux fracture, i.e. Salter-Harris III fracture of anterolateral
aspect of distal tibial epiphysis, minimally displaced.
43. Triplane fracture
Salter-Harris type 4
Multiplanar CT scans are ideally suited to visualize
these fractures in all planes
The name is due to the fact of the fracture
expanding both in frontal and lateral as well as
transverse planes
It comprises of
a vertical fracture through the epiphysis
a horizontal fracture through the physis
an oblique fracture through the metaphysis
Age
adolescents
44. Triplane fracture in adolescent
Tibial physis closed medially. Fracture in lateral tibia extending into epiphysis
and metaphysis consistent with Triplane fracture. No major dislocations.
47. Talar fracture
Location
Head
Neck
Body
Talar dome osteochondral fracture
Posterior talar process fracture
Lateral talar process fracture
48. Talar dome osteochondral defect/injury
These are are focal areas of articular damage with
cartilage damage and injury of the adjacent
subchondral bone
Plain x-ray findings can be normal in early stages
MRI more sensitive and specific
49. Anderson staging of osteochondral
defect
Stage I
“subchondral trabecular compression”
Plain film & CT negative
Bone marrow edema in MRI
Stage II
“incomplete separation of the fragment,”
X-ray – only thin sclerotic rim
IIa – if subchondral cyst
Stage III
“unattached, undisplaced fragment,”
Presence of synovial fluid in T2 around fragment
Stage IV
Displaced fragment
56. Bohler/Tuber/Calcaneal angle
Angle between 2 lines in
lateral film
Line 1 – vertex to
postero-superior edge
Line 2 – vertex to
anterior horn of
calcaneum
Normal
20-40
Less than 20 degrees in
calcaneal fracture
57. Gissane/critical angle
In lateral film, formed by
downward & upward
slopes of calcaneal
superior surface
Normal
120-145
Increased in calcaneal
fracture
58. Chopart fracture/injury
Fracture/dislocation of the mid-
tarsal joint i.e. talonavicular &
calcaneocuboid joints, which
separates hindfoot from midfoot
The commonly fractured bones are
calcaneum, cuboid & navicular
The foot is usually dislocated
medially & superiorly as it is
plantar flexed & inverted, usually
as a result of high energy impact
Where the foot is everted, lateral
displacement occurs
59. Lisfranc injury/fracture
are the most common type of
dislocation involving
the foot and correspond to the
dislocation of the articulation of
the tarsus with the metatarsal
bases
Displacement can also occur
from fractures at distal
metatarsals
60. A case of Lisfranc fracture/dislocation
Figure - Divergent Lisfranc dislocation in a 34-year-old who was the front passenger in
a motor vehicle accident. Radiographs were obtained in the emergency department.
Anteroposterior (A) and oblique (B) views of the foot reveal lateral dislocation of the
second through fifth metatarsals. The white arrow points to a fragment fractured off
the base of the second metatarsal.
Less obvious on the lateral view
62. Plantar fascia
dense collection of collagen fibres on the sole (plantar
surface) of the foot. These fibres are mostly longitudinal
but also transverse
Attachments
Posteriorly it attaches to the medial process of the tuberosity
of the calcaneus, proximal to flexor digitorum brevis. It is
narrow and thick at this attachment and becomes more broad
and thin distally and anteriorly.
Anteriorly it divides into five heads, one for each toe, just
proximal to the heads of the metatarsals. The superficial
layers of these fibres insert into the dermis at the ball of the
foot and the crease between the ball and the toes via the
retinacula cutis (skin ligaments). The deep layers of each digit
become septa that separate the digital flexor tendons from
the lumbricals and the digital vessels and nerves.
Laterally it covers abductor digiti minimi.
Medially it covers abductor hallucis and merges with
the flexor retinaculum and dorsalis paedis fascia.
65. Plantar fascitis
Most common cause of pain in heel
is a stress reaction occurring at the origin of the
plantar aponeurosis from the calcaneus, typically at
the medial calcaneal tubercle.
Etiology - degenerative changes from repetitive
microtrauma in the origin of the plantar fascia cause
traction periostitis and microtears
66. Imaging Plantar Fascitis
Plain radiograph
Non-specific
Associated calcaneal spur can be found
MRI
Thickened >4.5 mm
Edema around the origin of the aponeurosis
there may be edema in the underlying calcaneal
bone marrow
67. A case of plantar fasciitis –
Thick fascia near origin with high signal intensity
68. Plantar fascial tear
refer to disruption of plantar fascial fibres which
can occur in associated with longstanding plantar
fascitis or those treated with steroid injections.
The tears can be complete (i.e. rupture) or
incomplete.
MRI – T1WI
absence of T1-weighted low signal intensity at the site
of complete rupture or partial loss of T1-weighted low
signal intensity.
70. Brodie’s abscess in distal tibia
chronic intraosseous abscess resulting from
incomplete resolution of acute osteomyelitis
Distal tibial metaphysis – 1 of the common location of
brodie’s abscess.
Rarely cross the growth plate & epiphysis in children
Age- children with unfused epiphyseal plates
Pathology – Staphylococcus aureus
71. Imaging
Plain radiograph
lytic lesion often oval that is oriented along the long axis of
the bone
surrounded by a thick dense rim of reactive sclerosis
Periosteal reaction - +-
CT
central intramedullary hypodense cystic lesion with thick rim
ossification
Extensive periosteal reaction and bone sclerosis around the
lesion
MRI
T2 & STIR hyperintense rim with surrounding hypointense
sclerotic rim
Adjacent bone marrow edema +-
72. Case of 13 yrs. Old with Brodie’s abscess in distal tibia
Lytic lesion in
metadiaphyseal
region of distal tibia
MRI
Bilobed T1 hypointense and T2 hyperintense lesion
with surrounding sclerosis.
Adjacent marrow edema is also present
73. Soft tissue masses/tumors around Ankle
I. Synovial cysts or ganglia
II. Schwannomas
III. Plantar fibromas
IV. Giant cell tumor of the tendon sheath
74. Synovial cysts or ganglia
Most common around ankle & foot
are para-articular fluid-filled sacs or pouch-
like structures containing synovial fluid and lined by
synovial membrane
MRI – uniformly bright on fluid-sensitive images
75. Synovial cyst in 51 year old
Lateral radiograph shows a
round soft tissue mass
dorsal to the metatarsals
T1 – Iso
T2 – Bright
Post contrast – peripheral
enhancement
76. Plantar fibromas
Plantar fibromas can have variable signal
characteristics but are typically dark on all sequences
These are usually found in the plantar fat adjacent to
the aponeurosis, usually close to the calcaneus
77. A case of Plantar fibroma in a 44-year-old
Coronal T1-weighted (A), proton-density–weighted
(B), and T2-weighted (C) images reveal that the lesion (arrows) is relatively dark on
all sequences and confined to the fat of the plantar heel pad
78. Giant cell tumor of tendon sheath
is a localized form of pigmented villonodular synovitis
usually benign lesions that arise from the tendon
sheath
localized solitary subcutaneous soft tissue nodules
79. Plain radiograph
they may cause pressure erosions on the underlying
bone in 10-20% of cases
more commonly these masses arise from the palmar
tendons
the mass itself is of soft tissue density
periosteal reaction and calcification are uncommon
80. MRI
T1WI
low signal
T2WI
low signal
Post contrast
moderate enhancement
GRE
low and may demonstrate blooming
81. Case of Giant cell tumor of tendon sheath in 18 year-old
A well defined oval shape mass is seen anterior to the talus, extra articular in
position and underneath the tendon of the Extensor hallucis longus. The mass
displays low signal on T1, lower signal on T2 likely from hemosiderin deposition,
heterogeneous high signal on STIR, and avid enhancement on post contrast study.
No evidence of infiltration of the adjacent structures.
82. Retrocalcaneal Bursitis
refers to inflammation of the retrocalcaneal bursa,
which lies between the antero-inferior calcaneal
tendon and posterosuperior calcaneus.
It forms part of Haglund syndrome.
Note – there is another 1 bursa i.e. subcutaneous
calcaneal bursa (between the tendon and the skin)
rarely occurs in isolation and is almost always
associated with calcaneal tendinitis and/or Haglund
deformity
Bursae - are small fluid-filled sacs lined by synovial
membrane with an inner capillary layer of synovial
fluid
84. Imaging
Plain film
prominence of the posterosuperior calcanum can be
frequently seen 1
decreased lucency of the retrocalcaneal soft tissue (Kager
triangle)
Ultrasound
bursa distension by a hypoechogenic fluid collection: > 1 mm
anteroposteriorly, > 7 mm craniocaudally, or > 11 mm
transversely is considered abnormal
MRI
fluid collection:
T1: low signal
T2: high signal
STIR: high signal
86. Haglund syndrome
Refers to Haglund triad of
1) insertional Achilles
tendinopathy
2) retrocalcaneal bursitis
3) posterosuperior
calcaneal exostosis
Associated with calcaneal spurs
Wearing high heels
Stiffed backed shoes
87. Imaging
Plain film
loss of the Kager triangle due to retrocalcaneal bursitis
Achilles tendon measuring over 9 mm in thickness 2
cm above the bursal projection due to Achilles
tendinopathy
Postero-superior calcaneal spur
MRI
focal enlargement and abnormal signal at Achilles
tendon insertion segment
retrocalcaneal and retroachilles bursal fluid collection
calcaneal bony spur better appreciated on T1 sagittal
images
marrow oedema of the posterior calcaneal tuberosity
88. Case of Haglund syndrome in 20 yrs. male
High signal near
achilles insertion
89. Achilles tendinopathy
Macroscopically, tendinopathy results in
enlargement, disruption of fibrillar pattern and an
increase in tendon vascularity
Ultrasound
shows thickening and rounding of the affected portion of the
tendon. The cutoff value of 1 cm in anteroposterior diameter
is usually used for diagnosis.
Additional signs include increased Kager’s fat pad
echogenicity.
MRI
shows increased intratendinous signal and tendon
enlargement, with oedema in Kager's fat pad in cases of
tendinosis.
90. Case of Achilles tendinopathy.
Patient with pain on dorsiflexion
Thickening of the achilles tendon
on the lateral view of the ankle can
be seen 5-6 cm above its insertion
into the calcaneum
91. Achilles tendon tears
Pathology
interstitial tears (parallel to the long axis of
the Achilles)
partial tears
complete tears.
Location
ruptures in the 'critical zone', which is a region
of relative watershed hypovascularity 2-6 cm
proximal to insertion
92. Kuwada classification of Achilles
tendon tear
type I: partial ruptures ≤50%
typically treated with conservative management
type II: complete rupture with tendinous gap ≤3 cm
typically treated with end-end anastomosis
type III: complete rupture with tendinous gap 3 to 6 cm
often requires tendon/synthetic graft
type IV: complete rupture with defect of >6 cm (neglected
ruptures)
often requires tendon/synthetic graft and gastrocnemius
recession
93. Case of Kuwada type I tear
thickened and hypoechoic right Achilles tendon with discontinuation of its deep
fibers at its insertion site at calcaneum with adjacent fluid.
Findings are suggestive of tendinopathy with partial thickness tear
involving less than 50% fibres
94. Case of Kuwada Type II tear
Achilles tear, just above the insertion