Seminars in Musculoskeletal Radiology最新文献

Rosai-Dorfman disease is an uncommon proliferation of non-Langerhans cell histiocytosis that mainly affects lymph nodes, although occasionally it can be associated or even present solely with extranodal involvement including skin and subcutaneous fat infiltration.We present a case of cutaneous Rosai-Dorfman disease that occurred at the site of administration of COVID-19 vaccine. The patient was a 13-year-old Bahraini girl who presented with a 1-year history of left upper arm pain and swelling that started after receiving the Pfizer vaccination for COVID-19. Clinically, the mass was medium-sized, tender, and nonmobile. Ultrasound and magnetic resonance imaging were suspicious for sarcoma. Ultrasound-guided biopsy revealed "subcutaneous panniculitis." Excision of the mass revealed a multinodular infiltrate of the subcutaneous fat composed of distinctive large histiocytes, with characteristic emperipolesis, positive for S100, CD68, and OCT-2, consistent with Rosai-Dorfman disease. We present a case of cutaneous Rosai-Dorfman disease as a complication of COVID-19 vaccination that was challenging for the pathologist, radiologist, and clinician.

Groin pain is a common issue in athletes, and an accurate diagnosis is crucial for effective management. The complexity of the groin's anatomy, including the pubic symphysis and adductor muscles, makes diagnosing injuries in this area challenging. Additionally, the maturation of the pubic apophysis, particularly in adolescent athletes, can lead to conditions like apophysitis that are often misdiagnosed as other groin injuries. A major challenge is the inconsistent terminology, with terms like "athletic pubalgia" and "sports hernia" used interchangeably, causing confusion. The 2015 Doha Agreement helped standardize the classification of groin pain into adductor-, iliopsoas-, inguinal-, and pubic-related types. This review highlights common mistakes in imaging interpretation, particularly in diagnosing adductor- and pubic-related groin pain. Magnetic resonance imaging is a key tool, offering superior soft tissue detail that is crucial for accurate diagnosis, but misinterpretation remains common. This review will help clinicians and radiologists improve diagnostic accuracy and thus ultimately enhance patient outcomes.

Errors are an unavoidable aspect of medical practice, and radiology is no exception. In musculoskeletal radiology, the complexity of anatomy, subtle imaging findings, and cognitive biases contribute to significant challenges in diagnostic accuracy. This article examines personal experiences with diagnostic cognitive and perceptual errors, identifying key lessons learned and strategies to mitigate future mistakes through case-based analysis. It highlights recurring themes such as overreliance on prior reports, failure to consider contradictory clinical evidence, and premature diagnostic conclusions. Key strategies for improvement are structured reasoning processes, active hypothesis testing, continuous education, and fostering a culture of collaborative learning. The integration of artificial intelligence in radiology is also emphasized as a valuable tool to enhance diagnostic accuracy and streamline workflows.By addressing errors proactively and adopting evidence-based strategies, radiologists can cultivate a positive, supportive environment that prioritizes continuous learning, clear communication, and diagnostic excellence. This article serves as a reminder that errors, although inevitable, offer opportunities for professional growth and systemic improvement in patient care.

The menisci are essential for knee joint stability and function. Magnetic resonance imaging (MRI) has proven to be an invaluable tool for evaluating a wide range of meniscal injuries, yet various injury patterns are underdiagnosed or misdiagnosed, potentially leading to persistent clinical symptoms and early joint degeneration. Additionally, these pathologies may be difficult to recognize both clinically and during arthroscopy. This review highlights commonly missed diagnoses, arranged in descending order of how frequently they are misinterpreted in routine practice: medial meniscocapsular junction tears, posterior root tears of the lateral meniscus, posterior horn tears of the lateral meniscus, lateral meniscocapsular junction tears, and posterior root tears of the medial meniscus. We also delve into relevant anatomy, normal MRI appearances, injury findings and patterns, differential diagnoses, and tips for image interpretation. By understanding these commonly missed injuries and using a targeted search strategy, radiologists can enhance diagnostic accuracy and improve patient care.

Magnetic resonance imaging is the gold standard imaging tool to identify and characterize shoulder disorders involving bone and soft tissues. The spatial and contrast resolutions of magnetic resonance imaging allow for visualization of complex anatomical structures and subtle pathologies. Diagnostic sensitivity and specificity are excellent, but accurate magnetic resonance imaging interpretation does require knowledge of developmental variations that can be confused with symptomatic abnormalities. In this article, we review commonly encountered magnetic resonance imaging findings that are normal and asymptomatic but can mimic treatable shoulder lesions.

Accurate diagnosis of bone and soft tissue tumors is critical for effective management, yet radiologic errors remain a significant challenge and may lead to inappropriate interventions or delays in adequate treatment. This article describes common radiologic mistakes encountered in evaluating these tumors, including key errors such as mischaracterizing benign versus malignant lesions, overreliance on single imaging modalities, and failure to integrate clinical and histopathologic data. We focus on imaging features that help differentiate benign from malignant lesions. The article also highlights situations in which imaging alone cannot help with accurate differentiation.

The anatomy of the wrist and hand is complex due to small and closely opposed bone and soft tissue structures. The complexity of the wrist and hand anatomy simultaneously allows a wide range of motion yet also makes these joints vulnerable to injury. The large number of potentially involved structures can make adequate evaluation of the traumatized wrist challenging. Injury to the wrist or hand is often significant because of the risk of permanent functional impairment.Additionally, traumatic injury can be easily overlooked because signs may be subtle on conventional radiology and satisfaction of search poses risk of incomplete assessment. Other potential factors that create risk of errors in wrist assessment are nonstandardized acquisition, overlooking subtle signs of osseous trauma, neglecting soft tissue trauma, not performing additional imaging despite persistent suspicion of traumatic injury, traumatic injury, and misinterpretation of normal variants and trauma mimics.Thus adequate clinical information on the radiology request is essential to initiate an optimized imaging strategy to detect fractures or dislocations and identify normal variants. This review offers examples of pitfalls when assessing conventional radiographs of the wrist and recommendations on when additional imaging using ultrasound, computed tomography, or magnetic resonance imaging is needed.

In 1823, when William Webb Ellis picked up the football and ran with it when playing in a school match for Rugby School in England, the game of rugby was born. In 1845, that same school wrote the first rules of the game, and in 1871 the English Rugby Football Union was created. Since that time, the game has flourished and spread across the world, from England to the four corners of the globe. The game of rugby thrives on athleticism, skill, and bravery. Due to the nature of the game, collision-based injuries are common. However, as the sport has grown in the professional modern era, the players are also susceptible to many noncontact injury patterns. The array of injuries encountered in rugby places radiology central to player welfare and injury management. This article illustrates the range of injuries commonly encountered in one of the fastest growing full-contact sports in the world.

Football (soccer) is an intensely physical sport with a high prevalence of musculoskeletal injuries. Diagnostic imaging is critical for evaluating and managing these injuries effectively. Football players are particularly prone to injuries involving the lower extremities, especially the knees. Goalkeepers, due to their unique role and use of hands, face a higher risk of upper extremity injuries. Understanding the biomechanics of trauma, such as rapid changes in direction and high-speed running, is essential for anticipating injury patterns. This review article examines the imaging characteristics of football-related injuries, emphasizing the biomechanical factors involved and the role of imaging in diagnosing and managing both acute and chronic conditions.