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Biopsy: Soft Tissue

Abstract Indications The incidence of soft tissue sarcomas in the general population is very low, 1.4 to 2.7 per 100,000, increasing for patients 80 years of age and older to 8 per 100,000. The majority (59%) of soft tissue sarcomas occur in the extremities, with the most common types reported to be undifferentiated pleomorphic sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor. Although…

Normal Variants

Abstract Normal variants in the skeleton are commonly encountered in the practice of radiology. Kohler was the first to seriously address this subject in his book, Borderlands of the Normal and Early Pathologic Findings in Skeletal Radiology, which was published in 1968 and was limited to the skeletal system. Theodore E. Keats expanded the concept of normal variation to all of the subspecialties of imaging with…

Dental Imaging

Diagnosis of Mandibular and Maxillary Lesions The mandible and maxilla are unique bones in that they both contain teeth and tooth-forming tissues. This fact is responsible for the high rate of inflammatory diseases, such as osteomyelitis and of lesions of odontogenic origin and other possible bone-related diseases. Because of this wide spectrum of disease, the interpretation of diagnostic images of the maxilla and mandible can be…

Temporomandibular Joint

Pathophysiology Anatomy The temporomandibular joint (TMJ) is a diarthrodial joint bounded by the glenoid fossa and articular eminence of the temporal bone above and the mandibular condyle below (see Video 114-1 ). A joint capsule extends from the posterior portion of the temporal bone, glenoid fossa, and the articular eminence superiorly to the neck of the mandibular condyle inferiorly in the form of an inverted pyramid.…

Postoperative Infections

Etiology Postoperative infection of the hip and knee may occur in a myriad of clinical settings, including systemic infection or illness, blunt or penetrating trauma, or following medical intervention. Infection is both a primary complication and a medium through which deleterious effects may impact bone, muscle, neurovascular, and soft tissue as well as implanted materials. Complications may occur if there is delayed diagnosis of an infection,…

Imaging of the Residual Limb after Amputation

Amputation surgery is an ancient procedure dating back to prehistoric times. Although there have been numerous advances in limb salvage techniques, amputation is still performed today and may be the treatment of choice in cases of severe vascular disease, severe trauma, and some malignant neoplasms. In the United States, most amputations are performed in patients with diabetes mellitus and peripheral vascular disease, with amputations in this…

Postoperative Ankle and Foot

More than 200 distinct operations are performed in the ankle and foot. Indications for operative intervention include traumatic, overuse, degenerative, arthritic, congenital, neoplastic, and inflammatory conditions. Procedures unique to the foot and ankle are reviewed here, with emphasis on the imaging techniques used to evaluate successful and complicated operations. Osteosynthesis Description The most commonly performed operations in the foot and ankle—fracture treatment, osteotomies, and arthrodeses—are designed…

Postoperative Knee

Imaging the postoperative knee can be challenging. The postoperative knee can have all of the pathologic processes of the preoperative knee, in addition to specific issues related to the surgery performed, general problems with surgery, and specific postoperative complications. The imaging is often confounded by artifact produced from instrumentation or surgical scar, so that, often, special imaging technique is required, especially for CT and MRI. Because…

Postoperative Hip

Postoperative Imaging in Arthroscopic Hip Surgery In recent years, there has been considerable growth in arthroscopic hip surgery as a modality for both investigation and treatment of hip pathology. In this chapter, the postoperative imaging appearances of the hip are described following arthroscopic surgery. Postoperative Imaging of the Labrum Postoperative MR arthrography in patients who have undergone traditional labral débridement portray the normal triangular labrum as…

Postoperative Elbow, Wrist, and Hand

Elbow, wrist, and hand surgery are frequently done to repair bone and soft tissues, such as fractures and disruptions of ligaments and tendons. Nerves also traverse the area and are released from various tunnels. In this chapter, common indications are discussed for surgery on various bone and soft tissue structures in and around these joints, and some of the procedures with their postoperative imaging appearances are…

Postoperative Shoulder

Recurrent or persistent pain is a common complaint after shoulder surgery. MRI and ultrasonography (US) are often performed in the postoperative setting as a noninvasive means of determining the etiology of postoperative pain. Numerous surgical and arthroscopic techniques are available to the surgeon, and many of these procedures result in a change to the normal anatomy of the shoulder. An accurate interpretation of a postoperative shoulder…

Principles and Complications of Orthopedic Hardware

Evaluating the postoperative patient is integral to the practice of musculoskeletal radiology. Most of the subsets of musculoskeletal pathology, including trauma, neoplasia, arthritis, sports medicine, and congenital and developmental maladies, encompass many diagnoses and entities that lead to surgical intervention. The radiologist must combine knowledge of normal and abnormal reparative processes with understanding of the pathology, surgical procedures, and various implants and devices to render adequate…

Spinal Deformity

Classification and Definitions Many different classification systems have been described for spinal deformities. Over the years, some of these classifications have fallen out of favor while new descriptive terms have been applied. To accurately diagnose a spinal deformity, it is important to understand the definitions of the terms used. Spinal deformities are described in relation to the position of the deformity within the spine, the characteristics…

Dysplasias

Achondroplasia Achondroplasia belongs to group 1 of the osteochondrodysplasias, as listed in the International Nosology and Classification of Genetic Skeletal Disorders. It is one of the more common skeletal dysplasias, with a prevalence ranging from 1 : 15,000 to 1 : 40,000 live births. The incidence increases with increasing paternal age. It is usually inherited as a sporadic autosomal-dominant (AD) condition. The homozygous state is lethal. Achondroplasia arises from a…

Coalitions

Coalition represents abnormal fusion between two or more bones; it occurs more commonly in the bony tarsus but is also seen in the carpal bones. The condition may be congenital or acquired. Coalitions may be complete or incomplete and are bony (synostosis), cartilaginous (synchondrosis), or fibrous (syndesmosis). Carpal coalition is often an incidental finding, although fused bones are known to be more prone to fracture. On…

Developmental Dysplasia of the Hip

Etiology and Prevalence Congenital dislocation of the hip is a condition that presents in infancy in approximately 1 in 9000 live births. Although childhood presentation of the condition is uncommon, the occult form of developmental dysplasia occurs frequently. This consists of a shallow acetabulum that is potentially unstable, thereby leading to a premature degeneration and osteoarthritis seen in early adult life ( Fig. 102-1 ). There…

Focal Growth Disturbances

Etiology Teratogenic factors due to drugs taken during pregnancy are the best known cause of focal growth disturbances (e.g., thalidomide-associated phocomelia), but sporadic cases of unknown cause are now more frequent. This is due principally to the greater precautions taken in prescribing medications during pregnancy. Sporadic cases with focal growth disturbances may be due to somatic mutations in genes that regulate growth and cell division. The…

Monitoring Therapy in Bone and Soft Tissue Tumors

Pathophysiology The histologic response to neoadjuvant chemotherapy is one of the most important prognostic factors for patients with bone or soft tissue sarcoma who are scheduled for surgical treatment. Patients whose tumors show little necrosis relative to the fraction of viable tumor after neoadjuvant chemotherapy have poorer survival than patients with tumors that have more chemotherapy-induced necrosis. The amount of spontaneous, or non–chemotherapy-induced, necrosis as a…

Staging Bone and Soft Tissue Tumors

Staging encompasses determination of local tumor extent, including skip lesions, and identification or exclusion of distant metastases. Information on local extent and distant spread is a requisite for treatment planning, as discussed in Chapter 98 . Magnetic resonance (MR) is the preferred technique for local staging and should be performed before the lesion is sampled because postbiopsy changes such as hemorrhage can exaggerate the extent of…

Treatment Strategies for Musculoskeletal Tumors and Tumor-Like Lesions

Surgical treatment of a patient with a musculoskeletal tumor is aimed against the disease but often also affects functional ability of the patient for the rest of his or her life. Disability related to treatment can be minimal in small, benign tumors located in the extremities, or it can be devastating after surgical treatment of axial malignant tumors. The outcome is in many ways uncertain. The…