Laercio Alberto Rosemberg

Erratum to: MRI features of the anterolateral ligament of the knee

Page 1, Results section of Abstract A completely visible ligament had a mean length of 33.2 mm, thickness of 5.6 mm, and width of 1.9 mm. Where it should have read as: A completely visible ligament had a mean length of 33.2 mm, width of 5.6 mm, and thickness of 1.9 mm. Page 4, First paragraph of Reading parameters and statistical analyses of Results A completely visible ligament had a mean length of 33.2 mm (range, 24.1–39.9 mm), thickness 5.6 mm (range, 4.4– 7.1 mm), and width 1.9 mm (range, 1.2–2.5 mm). Where it should have read as:

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Multiple myeloma complicated with pseudomonas endocarditis.

Patients diagnosed with multiple myeloma are more susceptible to infections which are the major causes of morbidity and mortality associated to this disease. The main infectious agents involved are Gram-positive bacteria. However, after chemotherapy an increase in the incidence of Gram-negative strains is observed. These bacteria are also responsible for most cases of urinary tract infections. Here is reported a rare case in a 73-year-old man with multiple myeloma who developed endocarditis due to pseudomonas.

Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scnas showed hyperintense signal.

Foot drop after a suicide attempt

A 33-year-old male presented with a 2-month history of left foot drop, starting upon waking up 3 days after a suicide attempt with ingestion of high doses of phenobarbital, clonazepam, and alcohol. Painful left drop foot, trophic changes in the lower extremities, and bilateral Achilles areflexia were noted. Magnetic resonance neurography (MRN) of the lumbosacral plexus and left thigh showed thickening and signal intensity (SI) abnormality in the left sciatic nerve along the pelvic outlet and proximal thigh (Fig. 1). Denervation of the lumbosacral plexus affecting the quadratus femoris, piriformis, obturator, and adductor muscles with areas without contrast enhancement consistent with myonecrosis was seen on the pelvis, while denervation of the hamstring muscles related to sciatic neuropathy was seen on the thigh (Fig. 2). Electroneuromyography showed complete motor and sensitive axonal impairment of the left peroneal nerve, partial impairment of the left tibial nerve (with reinnervation), and partial impairment of the left femoral nerve. A compressive-ischemic mechanism after a long-term sideways position during unconsciousness was indicated as the cause of the clinical and imaging findings in this case. Sciatic neuropathy is the second most common cause in the legs, after peroneal neuropathy, and may be caused by acute or chronic compression, stretching, ischemia, laceration, or toxic injury (injections) as well as iatrogenic lesions (hip arthroplasty). Increased pressure on the nerve can cause injury either directly or indirectly as a result of compression of the vasa nervorum if the ischemia is prolonged, which was the most likely mechanism in our case [1, 2]. The sciatic nerve derives from the fourth and fifth lumbar and first and second sacral roots, coursing down deeper to the piriformis muscle with anatomical variations. It continues posteromedially to the hip and distally deep in the thigh before dividing into the tibial and common peroneal nerves above the popliteal fossa [2, 3]. MR imaging patterns vary depending on the muscle denervation stage: acute and subacutely denervated muscles show high SI on fluid-sensitive images and normal SI on T1-weighted images; in chronic denervation, muscle atrophy and fatty infiltration demonstrate high SI on T1-weighted images in association with volume loss [4]. On the other hand, myonecrosis is revealed by high SI on T1-weighted images, heterogeneously high SI on T2weighted images, and rim enhancement on contrastenhanced images [5]. A possible overlap of denervation No related papers from the same study have been published or submitted.

PLANTAR THROMBOPHLEBITIS: MAGNETIC RESONANCE IMAGING FINDINGS

Objective: Demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis. Methods: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. Results: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method. Conclusion: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain.

Tromboflebite plantar: achados em ressonância magnética

OBJECTIVE: demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis. METHODS: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. RESULTS: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method.

Demystifying MR Neurography of the Lumbosacral Plexus: From Protocols to Pathologies

Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.

Subclinical Propionibacterium acnes infection estimation in the intervertebral disc (SPInE-ID): protocol for a prospective cohort

Introduction Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. Methods and analysis An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume. Ethics and dissemination This study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs. Trials registration number NCT0315876; Pre-results.

“Fish-mouth” vertebrae in sickle cell anemia

The consecutive vertebral central depression seen in sickle cell anemia vertebrae is known as ‘‘fish-mouth’’ (Figs. 1, 2) vertebrae due to the similarity of upper vertebral inferior endplate together with lower vertebra superior endplate and a fish with opened mouth [1] (Fig. 3). It is thought to be secondary of subchondral infarctions of the central endplates and subsequent disk compression of the infarcted bone, leading to the deformity and arching of endplates. The peripheral portions of the endplates are usually spared because of collateral circulation [1, 2]. ‘‘Fish-mouth’’ vertebrae may be found eventually in abdominal and pelvic radiographs, CT and MRIs. Therefore, they should be recognized. Although present in up to 10% of the patients with sickle cell anemia, those vertebral alterations are non-specific and were also described in Gaucher’s disease [3, 4].