Vacuum phenomenon: Clinical relevance

Abstract

Vacuum phenomenon (VP) is an anatomical entity of potential confusion in the diagnosis and evaluation of joint pathology. Observation of this phenomenon has been demonstrated on basic radiographs, computed tomography, and magnetic resonance imaging. Although VP is most often associated with degenerative joint disease, it is observed with other pathologies. Two problematic scenarios can occur: a false-positive diagnosis of serious pathology instead of benign VP and a false-negative diagnosis of benign VP with a more serious underlying process Despite this potential for confusion, criteria for distinguishing VP from other causes of joint pain and for evaluating a suspected case of VP have not been fully established. We reviewed the literature to determine underlying mechanism, symptomology, associated pathologies, and clinical importance of VP. The formation of VP can be explained by gas solubility, pressure-volume relationships, and human physiology. CT, GRE-MRI, and multipositional views are the best imaging studies to view VP. Although most cases of VP are benign, it can be associated with clinical signs and symptoms. VP outside the spine is an underreported finding on imaging studies. VP should be on the differential diagnosis for joint pain, especially in the elderly. We have proposed criteria for diagnosing VP and generated a basic algorithm for its workup. Underreporting of this phenomenon shows a lack of awareness of VP on the part of physicians. By identifying true anatomic VP, we can prevent harm from suboptimal treatment of patients.

Vertebral column deformity with curved cross‐stitch vertebrae in Norwegian seawater‐farmed Atlantic salmon, Salmo salar L.

“…The presence of gas is frequently identified on CT studies of humans (Abbas, Hamoud, Peled, & Hershkovitz, ; Pfirrmann & Resnick, ; Samartzis et al, ) and dogs (Müller, Ludewig, Oechtering, Scholz, & Flegel, ; Weber, Berry, & Kramer, ) with intervertebral disc disease. The condition has been associated with pain in humans (Belfquih, El Mostarchid, Akhaddar, Gazzaz, & Boucetta, ; Gohil, Vilensky, & Weber, ). Hence, the findings in the fish with curved cross‐stitch could be an animal welfare concern.…”

T2 black lesions on routine knee MRI: differential considerations

“…T2 dark marrow lesions encompass a broad spectrum of congenital (bone island, osteopoikilosis), acquired (renal osteodystrophy, mastocytosis, hemosiderosis), metabolic (Erdheim chester disease, Gaucher disease, bone infarct) and neoplastic conditions (osteosarcoma, healed non-ossifying fibroma, fibrous dysplasia, etc. [2]. In this article, the authors focus on the MRI features of hypointense T2 soft tissue lesions on routine knee MRI and outline a systematic diagnostic approach towards their evaluation (Fig 1).…”

Vacuum Phenomenon of the Sacroiliac Joint: Correlation with Sacropelvic Morphology

“…The vacuum phenomenon (VP) refers to collection of gas within the joint space [6]. Intervertebral VP is usually associated with degenerative disc disease, which can be associated with low back pain.…”