Benjamin Levine

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

Morel-Lavallée 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-Lavallée 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-Lavallée lesions, such as soft tissue sarcoma and hemorrhagic prepatellar bursitis, are compared and contrasted. Treatment options and a management algorithm are also briefly discussed.

CT of Rib Lesions

OBJECTIVE This article discusses how ribs are involved in a variety of traumatic, metabolic, inflammatory, neoplastic, and congenital disorders. CONCLUSION We review the normal anatomy pertinent to rib imaging and illustrate the key features of a variety of rib lesions, emphasizing the diagnostic value of CT.

Acute exertional medial compartment syndrome of the foot after playing basketball

Compartment syndrome of the foot is an uncommon event. The most common cause of compartment syndrome of the foot is a crush injury. Exceedingly rare is acute compartment syndrome of the foot occurring in the absence of trauma. We describe the clinical scenario involving a 23-year-old healthy male who developed acute exertional compartment syndrome isolated to the medial compartment of the foot after playing basketball. The patient had no evidence of injury nor trauma, and the diagnosis was made based on physical exam, magnetic resonance imaging (MRI), and compartment pressure measurements. The patient did undergo successful fasciotomy on the day of presentation to the emergency department and has since completely recovered. We found four cases reported in the literature of acute exertional medial compartment syndrome of the foot in the absence of trauma or injury. This is the second case reported after playing basketball, while the others occurred after aerobics, a long distance run, and football. The most recent case was reported by Miozzari et al. [Am J Sports Med. 36(5):983–6, 2008] and involved a marathon runner who developed an isolated medial compartment syndrome of the foot. We would like to increase awareness of this uncommon clinical presentation in the absence of trauma and present the dramatic radiographic findings.

Subcutaneous panniculitis-like T-cell lymphoma: MRI features and literature review.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) represents a rare subclassification of peripheral T-cell lymphoma (PTCL). We present a case of a 21-year-old female who presented with a 1-month history of pain in the left buttock and hip, tender left inguinal lymph nodes, fevers, and night sweats. Percutaneous core needle biopsy was diagnostic for SPTCL with CD8+ cells positive for cytotoxic granules. Magnetic resonance imaging (MRI) features of SPTCL with a review of the literature are discussed.

Clavicular and meningeal alveolar soft part sarcoma: An unusual case and literature review

INTRODUCTION Alveolar soft part sarcoma (ASPS) commonly arises in the soft tissue of the lower extremities. Primary bone involvement is rare. METHODS/RESULTS We report a 23-year-old male who presented with pathologic fracture of the clavicle, and diagnosis of clavicular ASPS. Workup demonstrated a lumbar meningeal mass, also involving the vertebral bodies. CONCLUSIONS Few cases of primary bone ASPS have been identified. Most common primary bone involvement includes the fibula, ilium and tibia. Likewise, meningeal involvement is quite rare. In summary, primary bone ASPS is rare and may involve the clavicle. Meningeal involvement is likewise rare, and presumably represents metastatic spread.

MRI-Arthroscopy Correlation of the Rotator Cuff: A Case-based Review

With significant advancements over recent decades, magnetic resonance imaging (MRI) and shoulder arthroscopy are important complementary tools in guiding orthopedic surgeons to diagnosis, decision making, and treatment of rotator cuff pathology. The objective of this article is to review the basic principles and pearls of MRI-arthroscopy correlation of the rotator cuff through an overview of our approach to reading shoulder MRI followed by a case-based review of selected conditions. By understanding and comparing the subtleties of these modalities, radiologists and clinicians can better appreciate both the utility and limitations of MRI in predicting operative findings.

Synovial Tumors and Proliferative Diseases

The clinical diagnosis of synovial tumors and synovial proliferative processes is difficult, as symptoms and physical examination findings are often nonspecific. Advanced imaging modalities, such as MRI, high-resolution ultrasound, and computed tomography, can aid clinical decision-making by providing accurate diagnosis of such diseases in many cases. This article focuses on those specific imaging features of synovial tumors and proliferative processes that can provide accurate diagnosis and guide appropriate patient management.

Fractures through a biphalangeal toe: a pitfall to avoid

Background: The presence of two rather than three phalanges involving a lateral toe is a common variant. This is most often seen at the fifth toe. A fracture through the expected location of the distal interphalangeal joint can mimic a normal triphalangeal toe, leading to a delayed diagnosis. Methods: Over a thirty-four month period, records of fractures through a fused biphalangeal joint were kept by all members of the musculoskeletal imaging section of a large university. Results: Thirty-three patients with fractures through biphalangeal toes found on routine clinical examinations were included in the study. Demographic information, mechanism of fracture, and digit involved were recorded. Conclusions: Fractures occurring at the level of an expected interphalangeal joint are easily overlooked. Prompt diagnosis can improve patient outcomes.

Quantitative bone scan lesion area as an early surrogate outcome measure indicative of overall survival in metastatic castration-resistant prostate cancer.

179 Background: Bone Scan Lesion Area (BSLA) is a biomarker that can be computed semi-automatically from whole-body scintigraphic imaging as a measure of overall bone tumor burden. Initial development and validation, including correlation with outcomes, was performed in trial cohorts from a single drug treatment with controls in subjects with metastatic castrate-resistant prostate cancer (CRPC). A 30% increase/decrease in BSLA was defined as progression/response on bone scan. We hypothesize that, when applied to an independent treatment trial cohort with a different mechanism of drug action, baseline BSLA and Week 12 change post-treatment are predictive of a subjects overall survival. Methods: From an anonymized imaging research database a cohort of 198 CRPC subjects was identified who enrolled in a treatment trial (127 treated, 71 placebo). This cohort was independent of those used for biomarker development and initial validation, and involved a different mechanism of drug action. Subjects underwent sta...