Hoffa’s (infrapatellar) fat pad (HFP) is one of the knee fat pads interposed between the joint capsule and the synovium. Located posterior to patellar tendon and anterior to the capsule, the HFP is richly innervated and, therefore, one of the sources of anterior knee pain. Repetitive local microtraumas, impingement, and surgery causing local bleeding and inflammation are the most frequent causes of HFP pain and can lead to a variety of arthrofibrotic lesions. In addition, the HFP may be secondarily involved to menisci and ligaments disorders, injuries of the patellar tendon and synovial disorders. Patients with oedema or abnormalities of the HFP on magnetic resonance imaging (MRI) are often symptomatic; however, these changes can also be seen in asymptomatic patients. Radiologists should be cautious in emphasising abnormalities of HFP since they do not always cause pain and/or difficulty in walking and, therefore, do not require therapy.Teaching Points• Hoffa’s fat pad (HFP) is richly innervated and, therefore, a source of anterior knee pain.• HFP disorders are related to traumas, involvement from adjacent disorders and masses.• Patients with abnormalities of the HFP on MRI are often but not always symptomatic.• Radiologists should be cautious in emphasising abnormalities of HFP.
KEYWORDSBreast; Male breast; Ultrasonography.Abstract The male breast has been insufficiently explored in the medical literature, particularly that dealing with ultrasonography, although this topic is almost as vast and varied as that of the female breast. The purpose of this article is to provide a schematic review of the most frequent breast lesions encountered in males and their sonographic appearances. After a brief introduction on the anatomy of the male breast, the authors review the non-neoplastic (gynecomastia, pseudogynecomastia, cysts, inflammatory diseases, and Mondor disease) and neoplastic (benign and malignant) lesions encountered in this organ.Sommario La mammella maschile, seppur scarsamente trattata nella letteratura medica e in particolare in quella ecografica, rappresenta un argomento vasto e vario quasi quanto lo è la mammella femminile. Scopo di questo lavoro è inquadrare in modo schematico ed esaustivo le più frequenti lesioni mammarie nell'uomo e i rispettivi aspetti ecografici. Dopo una breve introduzione relativa all'anatomia della mammella maschile sono valutate prima le lesioni non neoplastiche, tra cui la ginecomastia, la pseudoginecomastia, le cisti, le patologie infiammatorie e la malattia di Mondor, quindi le neoplasie benigne e, in ultima istanza, quelle maligne. ª
Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral-or deltoid-ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar's triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures.Keywords Ultrasonography Á Ankle Á Achilles tendon Á Flexor tendons of the foot Á Extensor tendons of the foot Á Ligaments of the ankle Riassunto L'esame ecografico della caviglia è tra gli esami più richiesti nell'ambito dell'ecografia osteoarticolare; ne deriva la necessità di una conoscenza approfondita delle strutture anatomiche che la compongono. L'approccio ecografico per lo studio della caviglia è, per scopi pratici, organizzato per comparti; si analizzano nel presente pictorial essay le strutture del comparto anteriore (tendine tibiale anteriore, tendine estensore lungo dell'alluce, tendine estensore lungo delle dita, tendine peroneo tertius, retinacolo degli estensori), del comparto mediale (tendine tibiale posteriore, tendine flessore lungo delle dita, tendine flessore lungo dell'alluce, retinacolo dei flessori, legamento collaterale mediale o deltoideo, fascio vascolo-nervoso), del comparto esterno (tendini peronei breve e lungo, tendine peroneo quarto, retinacolo superiore ed inferiore dei peronei, legamento collaterale esterno), del comparto posteriore (tendine d'Achille, tendine del muscolo plantare, triangolo di Kager, borse sinoviali calcaneali superficiale e profonda). Si riporta inoltre qualche breve cenno di tecnica ecografica necessaria per l'ottimale visualizzazione delle strutture descritte.
We investigated the role of Power Doppler US in the diagnosis and follow-up of cholecystitis. We reviewed the examinations of 21 surgical patients aged 27-48 years with US findings of cholecystitis. We performed B-mode and then Power Doppler US. Wall thickness and US structure, the presence/absence of stones, and US Murphy's sign were assessed at B-mode US, whereas only the presence/absence of wall vascularization was studied with Power Doppler. B-mode and Power Doppler changes post treatment were also investigated. Ultrasound showed wall thickening in all patients. In addition, positive Murphy's sign and/or gallbladder stones were seen in 6 patients each at B-mode US and wall vascularization in 7 patients with Power Doppler. Acute cholecystitis was diagnosed in these patients. The other 14 patients presenting wall thickening but no vascularization and negative US Murphy's sign were diagnosed as having chronic cholecystitis; 10 of them had gallbladder stones. Two of seven acute cholecystitis patients were operated on in the acute stage for the onset of complications and histologic findings confirmed the US diagnosis. As for the remaining patients, histology diagnosed chronic cholecystitis in 17, whereas wall thickening was not inflammatory in 2 cases. All the cases with early wall vascularization were eventually diagnosed as cholecystitis. Power Doppler US permits confirmation of the diagnosis of acute cholecystitis and distinguishing of chronic disease, which helps in planning of surgery.
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