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Cumsky JL, Nguyen BD. PET/CT Imaging of Hemorrhagic Pseudotumor Arising From Treated Plasmacytoma. Clin Nucl Med 2022; 47:e565-e567. [PMID: 35439181 DOI: 10.1097/rlu.0000000000004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hemorrhagic pseudotumor occurs in approximately 1% to 2% of patients with hemophilia. This lesion is exceptionally rare in nonhemophiliac individuals. The authors present a case of treated right ischial plasmacytoma with a progressively enlarging expansile hemorrhagic pseudotumor, documented on 18 F-FDG PET/CT and MRI and confirmed by histology.
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Lee KC, Ahn KS, Kang CH, Hong SJ, Kim BH, Shim E. A Systematic Approach to Diagnosing Arthritis Based on Radiological Imaging. Curr Med Imaging 2022; 18:1160-1179. [DOI: 10.2174/1573405618666220428100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022]
Abstract
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Radiology plays key roles in diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis while productive disease includes osteoarthritis, and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologist to diagnose arthritis.
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Affiliation(s)
- Kyu-Chong Lee
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Suk Joo Hong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Euddeum Shim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
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Temporomandibular disorders in patients with inherited coagulation disorders: A clinical study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:473-477. [PMID: 34656803 DOI: 10.1016/j.jormas.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION One of the most common problems in patients with inherited coagulation disorders, especially hemophilia, is joint problems. This study aims to investigate whether temporomandibular joint (TMJ) is affected in patients with hemophilia or other coagulation factor disorders. MATERIAL & METHODS In this study, a patient group and a control group were formed. The patient group consisted of 44 individuals with hemophilia or other coagulation disorders (von Willebrand disease and rare factor deficiencies) and the control group consisted of 45 healthy individuals. In both groups, TMJ health was evaluated through a questionnaire and clinical examination. RESULTS The prevalence of signs and symptoms of temporomandibular disorders (TMD) that we evaluated was higher in the patient group than in the healthy individuals. Pain in the jaw, temple, in the ear or in front of the ear; pain in the jaw, temple, ear or front of the ear by opening the mouth or moving the jaw forward/sideways; closed locking (subjective); jaw joint noises (subjective) and TMJ noises during open & close movements on the right side in clinical examination were statistically significantly higher in the patient group than in the control group. DISCUSSION There are very limited studies on temporomandibular joint health in patients with coagulation factor deficiency. In this study, it was observed that patients with inherited coagulation disorders, especially hemophilia, were more likely to develop TMD than healthy individuals. This situation was thought to be due to the increased susceptibility to TMJ bleeding in patients with coagulation factor deficiency.
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Haemophilic Pelvic Pseudotumour: A New Surgical Option. Healthcare (Basel) 2021; 9:healthcare9101269. [PMID: 34682949 PMCID: PMC8536013 DOI: 10.3390/healthcare9101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1–2% of haemophilic patients. Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.
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Rodriguez-Merchan EC. Hemophilic arthropathy: current treatment challenges and future prospects. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1508341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nguyen K, Nguyen B. Hemorrhagic pseudotumors of iliac bones in Noonan syndrome: PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nguyen K, Nguyen B. Hemorrhagic pseudotumors of iliac bones in Noonan syndrome: PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2017; 36:197-198. [DOI: 10.1016/j.remn.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
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McAlindon T, Ward RJ. Osteonecrosis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ozcan HN, Ergen FB, Aydingoz U. Intraosseous pseudotumor in a child with hypofibrinogenemia. Pediatr Radiol 2014; 44:1458-61. [PMID: 24801817 DOI: 10.1007/s00247-014-3004-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/09/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022]
Abstract
Intraosseous pseudotumor (i.e. chronic, encapsulated, hemorrhagic fluid collection that can be seen in any portion of the tubular bones) is an uncommon complication of severe hemophilia; however, it can occur with other rare bleeding disorders. We present the case of an 11-year-old girl with hypofibrinogenemia who had multiple intramedullary lesions that were consistent with intramedullary pseudotumor associated with this rare bleeding disorder. Percutaneous biopsy of a pseudotumor is contraindicated due to the high prevalence of complications, including life-threatening bleeding. Therefore, radiologists should make the diagnosis with characteristic MR imaging findings in a patient with a severe coagulation disorder.
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Affiliation(s)
- H Nursun Ozcan
- Department of Pediatric Radiology, Hacettepe University Medical School, Fakülteler Mah. Dirim sok 22/3, Cebeci, 06590, Ankara, Turkey,
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Gupta V, Sandeep HS, Rai A, Shukla J. Functional and radiological assessment of arthropathy in Indian children with haemophilia. Haemophilia 2013; 19:e373-5. [DOI: 10.1111/hae.12215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 12/01/2022]
Affiliation(s)
- V. Gupta
- Department of Pediatrics; Institute of Medical Sciences; Banaras Hindu University; Varanasi India
| | - H. S. Sandeep
- Department of Pediatrics; Institute of Medical Sciences; Banaras Hindu University; Varanasi India
| | - A. Rai
- Faculty of Science; Centre for Genetic Disorders; Banaras Hindu University; Varanasi India
| | - J. Shukla
- Department of Pathology; Institute of Medical Sciences; Banaras Hindu University; Varanasi India
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Panotopoulos J, Ay C, Trieb K, Funovics PT, Stockhammer V, Lang S, Holinka J, Windhager R, Pabinger I, Wanivenhaus HA. Surgical treatment of the haemophilic pseudotumour: a single centre experience. INTERNATIONAL ORTHOPAEDICS 2012; 36:2157-62. [PMID: 22752668 PMCID: PMC3460086 DOI: 10.1007/s00264-012-1593-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Haemophilic pseudotumour was defined by Fernandez de Valderrama and Matthews as a progressive cystic swelling involving muscle, produced by recurrent haemorrhage into muscles adjacent to the bone. The pseudotumour mainly occurs in the long bones and the pelvis. The treatment of the haemophilic pseudotumour poses a challenge, and extensive clinical experience is essential to appropriately address this serious complication in patients with haemophilia. Consequently, the aim of this study is to present our own clinical experience and treatment results of the haemophilic pseudotumour. METHODS We retrospectively reviewed the records of 87 patients with bleeding disorders treated between 1967 and 2011 for musculoskeletal complications of congenital bleeding disorders. We identified six patients with a haemophilic pseudotumour who were treated at our department. RESULTS The mean age at surgery was 45.9 (range, 40-61) years. The iliac bone was affected in three patients (one right, two left), the right tibia (distal diaphysis) in one, the right thigh in two and the right ulna (proximal part) in one patient. One patient had two pseudotumours. The perioperative course was easily controllable with adequate factor VIII substitution. At the latest follow-up after 8.4 (range, 4-24) years, normal healing with no recurrence was observed. CONCLUSIONS The haemophilic pseudotumour is a rare but severe complication of hereditary bleeding disorders. In the international literature the resection and postoperative course are described as challenging and difficult, requiring detailed preoperative planning. It is advisable to perform such operations in specialised centres with close co-operation between surgeons and haematologists.
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Affiliation(s)
- Joannis Panotopoulos
- Department of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Jaganathan S, Goyal A, Gadodia A, Rastogi S, Mittal R, Gamanagatti S. Spectrum of synovial pathologies: a pictorial assay. Curr Probl Diagn Radiol 2012; 41:30-42. [PMID: 22085660 DOI: 10.1067/j.cpradiol.2011.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.
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Affiliation(s)
- Sriram Jaganathan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Jaganathan S, Gamanagatti S, Goyal A. Musculoskeletal Manifestations of Hemophilia: Imaging Features. Curr Probl Diagn Radiol 2011; 40:191-7. [DOI: 10.1067/j.cpradiol.2010.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kim HK, Zbojniewicz AM, Merrow AC, Cheon JE, Kim IO, Emery KH. MR findings of synovial disease in children and young adults: Part 1. Pediatr Radiol 2011; 41:495-511; quiz 545-6. [PMID: 21337125 DOI: 10.1007/s00247-011-1971-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 11/25/2010] [Accepted: 12/17/2010] [Indexed: 12/28/2022]
Abstract
Synovial diseases in children can be classified into normal structures as potential sources of pathology (synovial folds: plicae, infrapatellar fat pad clefts); noninfectious synovial proliferation (juvenile idiopathic arthritis, hemophilic arthropathy, lipoma arborescens, synovial osteochondromatosis, pigmented villonodular synovitis, reactive synovitis), and infectious synovial proliferation, deposition disease, vascular malformations, malignancy (including metastasis) and intra-articular/periarticular cysts and cyst-like structures (ganglia). Familiarity with characteristic MR imaging findings of synovial diseases in children and young adults will enable a more confident diagnosis for earlier intervention and directed therapy. The first part of this paper will cover potential pathology of normal synovial structures as well as noninfectious synovial proliferation.
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Affiliation(s)
- Hee Kyung Kim
- Department of Radiology, Cincinnati Children's Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
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McAlindon T, Ward RJ. Osteonecrosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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DORIA AS. State-of-the-art imaging techniques for the evaluation of haemophilic arthropathy: present and future. Haemophilia 2010; 16 Suppl 5:107-14. [DOI: 10.1111/j.1365-2516.2010.02307.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Feng Xue, Chaoxia Sun, Tao Sui, Lei Zhang, Lihui Jiang, Renchi Yang. Hemophilic Pseudotumor in Chinese Patients: A Retrospective Single-Centered Analysis of 14 Cases. Clin Appl Thromb Hemost 2010; 17:279-82. [PMID: 20460342 DOI: 10.1177/1076029610366433] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pseudotumor is an uncommon but severe complication in patients with hemophilia. To our knowledge, although China has large population of persons with hemophilia, there is rare information on the incidence, clinical feature, image finding, and management of pseudotumor among Chinese patients. This study aimed at improving our knowledge on clinical diagnosis and management of hemophiliac pseudotumor. In this retrospective study, the medical records of 1248 patients with hemophilia diagnosed between January 1983 and October 2004 at our hospital were reviewed. The clinical feature, imaging finding, management, and outcome of 14 patients with pseudotumor among these patients with hemophilia were analyzed. All patients have hemophilia A (8 severe cases and 6 moderate cases). Eight patients sustained an injury prior to the development of pseudotumor. Main image findings included osteolysis lesion, soft tissue swelling, or lump. Surgical therapy was carried out in 7 patients and 6 achieved remission, with fistula formation remaining in 1. One patient underwent radiotherapy together with replacement therapy achieved remission. Three patients accepted replacement therapy as only management and only 1 patient achieved improvement of swelling. Our study showed that the incidence of pseudotumor in our enrolled patients with hemophilia is 1.12%. Hemophilic history of patients can contribute to the right diagnosis of pseudotumor. Surgical therapy together with sufficient replacement therapy is safe and effective.
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Affiliation(s)
- Feng Xue
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Chaoxia Sun
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Tao Sui
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Lei Zhang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Lihui Jiang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Renchi Yang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
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Santos MK, Polezi MB, Engel EE, Pastorello MT, Simão MN, Elias Junior J, Nogueira-Barbosa MH. Apresentações incomuns no diagnóstico por imagem do pseudotumor intraósseo do hemofílico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Este estudo tem como objetivo descrever apresentações incomuns do pseudotumor do hemofílico no diagnóstico por imagem. MATERIAIS E MÉTODOS: Estudo retrospectivo com avaliação de cinco pseudotumores ósseos do hemofílico em dois pacientes. Os achados de imagem em dois pacientes hemofílicos tipo A foram avaliados em consenso por dois radiologistas musculoesqueléticos. Foram estudados exames de radiografia simples, tomografia computadorizada e ressonância magnética. RESULTADOS: Em uma das lesões analisadas a fase pós-contraste intravenoso da tomografia computadorizada mostrou áreas de reforço heterogêneo e de aspecto sólido no interior da lesão da coxa direita. Este aspecto foi confirmado no exame anatomopatológico da lesão em questão. Outro achado raro foi a identificação de dois pseudotumores intraósseos no úmero, separados por segmento de osso normal. E, por fim, também um pseudotumor do fêmur com extensão para partes moles e transarticular, com conseqüente acometimento da tíbia e patela. CONCLUSÃO: Os achados de diagnóstico por imagem acima descritos não são comumente relatados para os pseudotumores ósseos do hemofílico. É importante que o radiologista tenha conhecimento dessas apresentações mais raras.
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Constantine S, Buckley J, Heysen J. Imaging of the haemorrhagic complications of the haemophilias. J Med Imaging Radiat Oncol 2009; 53:13-21. [DOI: 10.1111/j.1754-9485.2009.02032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jacobson JA, Girish G, Jiang Y, Sabb BJ. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology 2008; 248:737-47. [PMID: 18710973 DOI: 10.1148/radiol.2483062112] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Jon A Jacobson
- Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910L, Ann Arbor, MI 48109-0326, USA.
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Kroonen LT, Gillingham BL, Provencher MT. Orthopedic manifestations and management of patients with von Willebrand disease. Orthopedics 2008; 31:263-7; quiz 268-9. [PMID: 18351047 DOI: 10.3928/01477447-20080301-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Von Willebrand Disease is the most common inherited bleeding disorder and can present challenges to orthopedic surgeons in managing perioperative bleeding and treating orthopedic problems that manifest as a result of the disease. Appropriate history taking is essential to identify these patients prior to surgery. The most effective management of von Willebrand disease will be achieved with close consultation between the surgeon, anesthesiologist, internist or pediatrician, hematologist, and patient. With appropriate planning, these patients can undergo major orthopedic procedures safely and effectively.
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Affiliation(s)
- Leo T Kroonen
- Department of Orthopedic Surgery, Naval Medical Center San Diego, California 92134-1112, USA
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Doria AS, Lundin B, Kilcoyne RF, Babyn PS, Miller S, Nuss R, Rivard G, Stephens D, Pettersson H. Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group. Haemophilia 2005; 11:245-53. [PMID: 15876270 DOI: 10.1111/j.1365-2516.2005.01097.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Effective treatment of haemophilic arthropathy requires a detailed evaluation of joint integrity. Methodological assessment of magnetic resonance imaging (MRI) scores are needed to assure reproducibility of measurements when comparing results of clinical trials conducted in different centres. We compared the reliability of two MRI scoring systems for assessment of haemophilic arthropathy: one progressive system that displays the most severe change and one additive system that depicts osteochondral and soft tissue-related changes. A total of 47 1.5 T MRI examinations of knees (n = 21) and ankles (n = 26) of 42 haemophilic boys, age range, 22 months to 18 years, performed at different centres (Toronto, n = 20, Europe, n = 12 and Denver, n = 15) were independently reviewed by four radiologists at two occasions. Twenty-two examinations were from children <9 years and 25 from children >/=9. Sagittal and coronal gradient-echo (MPGR, 3D FLASH with fat saturation, GRASS) images were obtained. The MRI examinations of the ankle and knee studies presented with osteochondral abnormalities in 38.5% and 23.8% of the cases respectively. The two scoring systems demonstrated an excellent inter-reader [progressive, 0.88; additive (A, e, s and h components), 0.86] and intra-reader [progressive, 0.92; additive (A, e, s and h components), 0.93] reliability using intraclass correlation coefficients (ICCs). Although ICCs were slightly higher for knees when compared with ankles, and for older children when compared with younger children, all values fell within excellent inter- and intra-reader reliability categories. The two MRI scoring systems demonstrated a comparable reliability. This result constitutes the basis for further development of a combined MRI scoring system for assessment of haemophilic arthropathy, which incorporates progressive and additive components.
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Affiliation(s)
- A S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
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