Brian J. Sabb

Radiographic Evaluation of Arthritis: Degenerative Joint Disease and Variations

In the presence of joint space narrowing, it is important to differentiate inflammatory from degenerative conditions. The presence of osteophytes, bone sclerosis, and subchondral cysts and the absence of inflammatory features such as erosions suggest osteoarthritis. Typical osteoarthritis involves specific joints at a particular patient age. When osteoarthritis involves an atypical joint, occurs at an early age, or has an unusual radiographic appearance, then other causes for cartilage destruction should be considered, such as trauma, crystal deposition, neuropathic joint, and hemophilia. There are several types of arthritis, such as juvenile chronic arthritis and gouty arthritis, that may have a variable appearance compared with that of other common inflammatory arthritides.

CT-guided biopsy of bone: a radiologist's perspective.

OBJECTIVE We present an overview of approaches for bone biopsy used to minimize potential tumor seeding of adjacent soft-tissue structures and compartments. We discuss a variety of approaches related to specific anatomic parts and review pertinent anatomy. CONCLUSION We provide important guidelines and key examples that will help readers perform percutaneous needle bone biopsy safely.

Musculoskeletal Sonography: Important Imaging Pitfalls

OBJECTIVE The purpose of this article is to describe the pitfalls that may be encountered when performing musculoskeletal sonography. CONCLUSION Sonography of the musculoskeletal system is a useful diagnostic technique, but awareness and understanding of the pitfalls will minimize errors in diagnosis.

Acoustic Access to the Prostate for Extracorporeal Ultrasound Ablation

This study aimed to measure acoustic access to the prostate for extracorporeal ultrasound ablation. Both transabdominal and transperineal approaches were considered. The objective was to measure the size and shape of the aperture available for unobstructed targeting of the prostate. CT images of 17 randomly selected men > 56 years of age were used to create 3D reconstructions of the lower abdomen and pelvis. Rays were traced from target locations in the prostate toward the perineum and the abdomen. The maximum CT density encountered along each path was recorded; those paths that traversed structures with CT density exceeding a soft tissue threshold were considered to be blocked by bone. Unblocked rays comprised the accessible aperture. The aperture through the perineum was found to be a triangular-shaped region bounded by the lower bones of the pelvis varying significantly in size between subjects. The free aperture through the abdomen was wedge shaped limited by the pubis and also with great subject-to-subject variability. Average unblocked fractions of an f/1 transducer to target base, middle, and apex of the prostate along the urethra from the perineum were 77.0%, 94.4%, and 99.6%, respectively. Averages targeting from the abdomen were 86.1%, 52.3%, and 11.0%. Acoustic access to the prostate for therapy through the perineum was judged to be feasible. Access from the abdomen was judged to be sufficient for the base of the prostate, but likely inadequate for the middle and apex.

Ultrasound evaluation of a spontaneous plantar fascia rupture.

Louwers MJ, Sabb B, Pangilinan PH: Ultrasound evaluation of a spontaneous plantar fascia rupture. Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48–9; Rolf et al, J Foot Ankle Surg 1997;36:112–4; Saxena and Fullem, Am J Sports Med 2004;32:662–5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively.

Non-Surgical Management of Achilles Ruptures

Incidence of Achilles tendon injury has increased as people continue to be active in their later years. Although acute rupture of the Achilles tendon is most commonly diagnosed using history and physical examination, improvements in magnetic resonance and ultrasound imaging have led to their routine use in evaluating these injuries. Non-operative versus operative management of acute Achilles tendon ruptures has been the subject of much controversy in the current literature, especially in light of non-operative treatment with functional bracing. This article highlights the current controversy and outlines the rationale for nonsurgical treatment of acute Achilles tendon ruptures.

Poster 216: Utility of Ultrasound in Evaluation of a Spontaneous Plantar Fascia Rupture: A Case Report

Disclosures: M. J. Louwers, None. Patients or Programs: A 37-year-old man with no history of foot pain, presenting with a spontaneous plantar fascia rupture. Program Description: The patient presented after experiencing medial left foot pain during a basketball game. The patient was abruptly changing directions when he felt a popping sensation and immediate, intense pain in the medial aspect of his left heel. The patient was able to walk with moderate discomfort but noticed bruising and swelling about 2 hours after the injury. There was no history of plantar fasciitis or any lower limb steroid injections. Examination revealed mild pes planus and hyperpronation of the midfoot bilaterally, with a small area of ecchymosis over the calcaneal origin of the left plantar fascia. Ultrasound of the left ankle and foot were performed and revealed severe fasciitis at the calcaneal insertion with partial tearing. Setting: Tertiary care hospital. Results: An Aircast boot was prescribed for 3 weeks for the left foot, as well as ibuprofen for pain relief. Afterward, we recommended minimal weight-bearing exercises for 2 additional weeks. At 5 weeks post injury, the patient was able to return to full activities without discomfort. Discussion: Plantar fascia tears are usually associated with pre-existing plantar fasciitis or previous steroid injections. Spontaneous rupture, however, has rarely been reported in the literature. Similar to the other reports of spontaneous rupture, our patient had no previous symptoms or steroid injections, but did have risk factors including pes planus and hyperpronation. Ultrasound offers unique benefits over MRI in evaluation of this pathology. Ultrasound is ideal for superficial structures such as the plantar fascia; it is reliable, compact and inexpensive. Moreover, it is fast, noninvasive, provides the option of real-time imaging for dynamic testing and is an excellent alternative for claustrophobic patients. Conclusions: Although rare, spontaneous rupture of the plantar fascia can occur during acceleration injuries such as running or jumping. In these patients, ultrasound provides a quick, accurate, and cost-effective means of evaluating plantar fascia tears. OTHER REHABILITATION TOPICS

Analysis of Acoustic Access to the Prostate Through the Abdomen and Perineum for Extracorporeal Ablation

As part of the development of a noninvasive treatment for BPH using histotripsy, this study aimed to measure acoustic access for extracorporeal ablation of the prostate. Both transabdominal and transperineal approaches were considered. The objective was to measure the size and shape of a transducer aperture that could target the prostate without obstruction. CT images obtained from 17 subjects >56 years of age were used to create 3D reconstructions of the lower abdomen and pelvis. Target locations on the urethra at the base, mid, and apex in the prostate were marked along with a transrectal imaging probe. Evenly space rays spanning were traced from each target location towards the perineum and separately towards the abdomen with the maximum x‐ray density encountered along each path recorded. The overall free aperture through the perineum was found to be a triangular shaped region bounded by the lower bones of the pelvis and the transrectal probe varying significantly in size between subjects. The free ape...

Developmental Venous Anomaly Complicated by Cerebral Venous Infarction

Developmental venous anomaly is a vascular malformation thought to be a benign embryologic variant. We describe a patient who presented with focal neurological deficits and parathesia due to an infarct associated with a developmental venous anomaly with a thrombosed draining vein.