Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on chest X-rays in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration of pain.

The ultrasonographic version of the Greulich-Pyle atlas can be used to estimate bone age even in ultrasonography departments. This method is highly correlated and a valid alternative to plain radiography for bone age estimation. This enables estimation of skeletal age in ultrasonography departments easily without exposing the patient to radiation.

Muscle herniation can be defined as protrusion of a portion of muscle through an acquired or congenital defect of enclosing fascia. Although it is usually a cosmetic problem, it can lead to local pain and tenderness after prolonged exertion. In this report, we present a case of flexor digitorum superficialis muscle herniation in a 58-year-old man. The radiographic, ultrasonographic and magnetic resonance imaging findings are described with dynamic examination, permitting demonstration of muscle herniation through the fascial defect during muscle contraction.

A B S T R A C TBackground and Purpose. Although essential tremor (ET) is one of the most common movement disorders, its pathogenesis remains obscure. The ventral intermediate nucleus of the thalamus (VIM nucleus) is suggested to play an important role in the occurrence of disease. In this study, the authors investigated the presence of biochemical or metabolic alterations in the thalamus of patients with ET using magnetic resonance (MR) spectroscopy. Methods. The study group included 14 patients with ET who suffered from tremor predominantly in their right arm and 9 healthy controls. All patients and controls were right handed. Following conventional cranial MR imaging, single voxel proton MR spectroscopy of the thalamus involving the VIM nuclei was performed bilaterally in both the patients with ET and controls. Metabolite peaks of choline (Cho), creatine (Cr), and Nacetylaspartate (NAA) were obtained from each spectroscopic volume of interest. The right and left thalamic NAA/Cr and Cho/ Cr ratios were compared first within the patient group and then between the control and patient groups. The differences in age and spectroscopic data between groups were assessed using the Mann-Whitney U test, whereas the comparison within groups between left thalamus and right thalamus was done by the Wilcoxon test. Results. In patients with ET, the NAA/Cr ratio of the right thalamus was found to be significantly higher than the NAA/Cr ratio of the left thalamus (P = .02). However, NAA/Cr and Cho/Cr ratios were found to be similar (P > .05) when we compared the control and patient groups for the right thalamus and then the left thalamus. Conclusion. These data present pre-liminary evidence for metabolic alterations of the contralateral thalamus (namely, low NAA/Cr ratio) in ET patients with predominantly involved right arm. However, the series is small and further data are necessary to clear the subject adequately.

We present the case of a late-onset urinoma in a 47-year-old man with a history of right ureterolithotomy performed 6 months previously, following 2 unsuccessful attempts at extracorporeal shock wave lithotripsy. The ipsilateral kidney was nonfunctional and hydronephrotic. The urinoma did not show enhancement on contrast-enhanced CT and intravenous pyelography. Sonography revealed turbulence in the urinoma and jet flow from the ureter. Lab studies of fluid obtained by percutaneous puncture and aspiration yielded misleading findings for urine and revealed the presence of hemosiderin-laden macrophages. The urinoma was surgically resected and ureteroneocystostomy was performed.