Tibial Tunnel Cyst

About diagnostic imaging of postoperative complication of anterior cruciate ligament (ACL) reconstruction.

This is the case of a patient the came to my observation for a palpable mass into the anterior-medial pretibial region, two years after ACL reconstruction.

Tunnel cyst formation is a rare complication after ACL reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. The ultrasound exam in this case is not enough. The study is completed with MRI and Cone-Beam CT examination.

Tibial Tunnel Cyst MRI

MRI-Cone-Beam CT

Why Cone-Beam CT? Same diagnostic capability of total-body CT but low radiation dose!

Low Radiation Dose

The computed tomography dose index (CTDI) is a commonly used radiation exposure index in X-ray computed tomography (CT); in this case 4,74 mGy was the value detected. 16.98 mGy is the estimated absorbed dose by using a total-body CT scan for the same examination.

Total-Body CT

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Vastus Lateralis Injury

about ultrasound and mri findings of vastus lateralis injury

 

This is the case of a young rugby player presenting an high degree strain of the vastus lateralis muscle at its proximal insertion, togheter with an aponeurotic fascial injury on the subcutaneous lateral side.

I always suggest to perform both the Mri and ultrasound investigations; with the Mri exam it is evident the bone marrow edema, due to the avulsion injury at the intertrochanteric line, suspected during the clinical evaluation but impossible to see on ultrasound exam.

Vastus Lateralis Injury

Coronal (left) and Sagittal (right) PD-Fs Mri scans (1.5 Tesla).

Vastus Lateralis Injury Axial Mri

Axial PD-Fs Mri scan (1.5 Tesla). The bone marrow edema and the avulsion injury are evident.

Subluxating Ulnar Nerve at the Elbow

about ultrasound findings of post-traumatic ulnar nerve subluxation

This is the case of a direct blow to a flexed elbow. The X-ray and Mri exams show a condylar fracture of the humerus, with a partial cortical bone detachment; a gross joint capsule distension is also evident.

Elbow Mri-xray

Coronal Xbone-T1w Mri scan (0.3 Tesla) and Plain Radiography.

Condylar Fracture

Coronal Stir (left) and T1w (right) Mri scans of the same patient (0.3 Tesla).

Why ultrasound in this case? Because after 1 month the patient feels pain on the posterior-medial aspect of the elbow, especially during the flexion-extension active movement, with distal pain irradiation to the forearm.

The dynamic ultrasound exam better depicts the clinical picture of a post-traumatic ulnar nerve subluxation at the sulcus ulnaris, togheter with a gross joint synovitis.

Ulnar Nerve Inflammation

Axial T2w (left) and Stir (right) Mri scans of the same patient (0.3 Tesla).

Medial Gastrocnemius Rupture

about ultrasound findings of complete detachment of medial gastrocnemius

In case of major traumas in the calf region, a reminder of its intrinsic anatomy is necessary; I suggest you to read an interesting paper in which all of the tirceps surae anatomical structures are perfectly depicted. https://www.ncbi.nlm.nih.gov/pubmed/25456712

Today I show you the case of a complete detachment of the medial gastrocnemius, togheter with the total rupture of the the so-called intramuscular aponeurosis of the soleus.

Axial Mri

Axial T2w (left) and Stir (right) Mri scans (0.3 Tesla)

The Mri images show a gross fluid collection in the aponeurotic space between medial gastrocnemius and soleus muscle; I always perform the ultrasound dynamic examination, both in the acute phase and especially during resting period. The elastosonography study is also useful in the monitoring of the fluid collection evolution.

The elastosonography study is also useful in the monitoring of the fluid collection evolution.

Imaging of TFCC Injury of the Wrist

about dynamic cone-beam ct imaging of TFCC wrist injury

It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.

I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a  stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.

TFC Injury

Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).

The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.

Bipartite Hallux Sesamoid Injury

about dynamic ultrasound and MRi findings of post-traumatic injury of a medial bipartite hallux sesamoid bone

Today I show you the injury of a medial bipartite hallux sesamoid bone in a professional football player; extremely painful after trauma, it takes time to heal.

Sesamoid

Standard X-Ray exam after trauma.

Medial Bipartite Sesamoid MRI

Sagittal (left) and Coronal (right) Ge-Stir Mri sequences (0.3 Tesla); bone marrow edema of the medial sesamoid is evident.

I always perform also the dynamic evaluation, both with ultrasound and Mri exams.

 

Dorsal Scapholunate Ligament Tear

about dynamic mri and ultrasound examination of carpal instability

In my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament I showed the usefulness of both ultrasound and Mri dynamic evaluation in the study of this important ligament structure. Today I want to show you the dorsal scapholunate ligament (SL) tear in a patient that came to my observation after a regular healing of post-traumatic scaphoid fracture.

SL Tear

Coronal Stir (left) and T1w (right)  Mri scans (0.3 Tesla): correct visualization with no artifacts of post-surgical treatment with scaphoid screw. Tear of the dorsal scapholunate ligament is evident (red arrow).

For the appropriate treatment is crucial to see also the dynamic behaviour of this kind of injuries. I always perform both ultrasound and Mri dynamic evaluation in these cases.

The dynamic ultrasound exam shows the post-traumatic carpal instability; dorsal SL tear is evident, togheter with the scapholunate dissociation and DISI picture.

For the correct ultrasound scanning please see my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament.

The Dynamic Mri evaluation (0.3 Tesla) during flexion-extension and ulnar-radial deviation confirms the clinical picture, better defining all the pathologic findings. The radiology technician plays a crucial role for this kind of examination, explaining to the patient the correct wrist movement during the Mri acquisitions.