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We describe the clinical features and MR-imaging findings of spontaneous spinal subarachnoid hemorrhage located in the lumbar spine associated with subdural hematoma at a higher, thoracic level in a 66-year-old man without neurological deficit. The sequential MR-imaging changes of hemorrhage at various stages in its evolution are portrayed. The possible pathogenetic mechanism for these very unusual, combined hemorrhages in both spinal compartments is discussed. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Four cases of computed tomography and magnetic resonance imaging documented lumbar nerve root compression associated with a vacuum disc communicating with the epidural space are presented. OBJECTIVE: To give an insight into the mechanism of nerve root compression associated with vacuum disc phenomenon. SUMMARY OF BACKGROUND DATA: Few cases of lumbar radiculopathy resulting from epidural gas have been reported and illustrated using cross-sectional imaging studies. METHODS: The medical records, imaging examinations, and surgical findings (when available) of 4 symptomatic patients with epidural and intradiscal gas collections were reviewed. Three patients underwent surgery with needle aspiration of the epidural gas, and 1 patient was treated conservatively. RESULTS: Clinical symptoms of epidural gas cyst were similar to those of other more common causes of nerve root compression. Computed tomography and magnetic resonance imaging findings showed intraspinal gas collection associated with a vacuum disc. One patient had an additional vertebral pneumatocyst. Although evacuation of intraspinal gas resulted in complete cure or major neurologic improvement in 3 patients, an initial period of observation is warranted because gas may disappear spontaneously as in 1 of our patients. All 4 patients recovered full motor and sensory functions of the lower extremities. One year later, patients were completely free of symptoms. CONCLUSION: Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar radiculopathy. [ABSTRACT FROM AUTHOR]

Foreign bodies (FBs) can pose a diagnostic dilemma because a wide range of objects, comprising items incidentally detected or deliberately retained in the body, can be discovered on imaging investigations. Single or multiple FBs may be retained at different sites including the gastrointestinal tract, the genitourinary system, the respiratory tract, and the soft tissues, all of which warrant medical attention. More importantly, ensuing, serious complications related to harmful positioning of these objects can significantly hamper normal function of any involved organ system. Because various FBs may be detected throughout the body, it is important that radiologists are also familiar with a myriad of life-threatening complications associated with retained items, including impaction, obstruction, perforation, hemorrhage, embolization, chemical dissolution, poisoning, and sepsis. Imaging plays a key role in the detection, localization, and characterization of FBs. Radiologists need to describe in exhaustive detail suspected items with regard to the anatomical location, type, shape, and composition of the object under investigation. Clinicians can then predict whether the foreign object(s) will pass through the body uneventfully or need to be addressed in a surgical procedure.

As the global population of older persons increases, age-related medical conditions will have a greater impact on public health. DXA-derived bone and soft tissue metrics are associated with adverse clinical events in aging persons. This study aims to investigate the regional body composition of the appendices by whole-body DXA scans, and the age-related relationships between measures of bone and soft tissue in healthy Caucasian females of a Greek origin residing in the Mediterranean area. Body composition of the legs and the arms was analyzed, and lean mass (LM) and fat mass (FM) metrics were calculated in 330 women aged 20-85 years, using DXA. Peak bone mineral density (BMD) of the legs and arms was achieved between ages 20-30 and 41-50 years, respectively. The overall BMD reduction with age was for the legs 43% and the arms 32.2% (p < 0.001). Peak %LM of the legs and the arms was achieved between ages 20-30. The overall reduction of %LM with age was for the legs 22.5% (p < 0.001) and arms 6.6% (p < 0.05). Peak %FM of the legs and arms was attained between ages 31-40 and 61-70, respectively. The overall %FM reduction with age was for the legs and arms 7.5% and 1.9% (p > 0.05). In appendicular sites, Greek women reach peak values of bone mass in the legs first, in early adulthood. Bone loss predominates in the legs as women age. Also, with advancing age Greek women show preferential significant decreases of %LM and %FM in the legs as opposed to the arms. Although variation in appendicular bone and soft tissue metrics is present, the implications of variable biological crosstalks among the tissue components as women age may ultimately lay the foundation for future clinical trials aimed at healthy aging., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The "tumbling gallstone sign" is a diagnostic imaging finding described on radiologic examinations of the abdomen, in patients with cholelithiasis associated with intermittent episodes of gallstone obstructive ileus.  Best seen on serial radiographs or CT studies of the abdomen, this sign indicates a sudden change in position of the gallstone(s) within the intestinal lumen from the upper segments of the bowel to the lower segments of the bowel, causing transient mechanical bowel obstruction.  The tumbling gallstone sign has been likened to that of the classic childrens' tumbling tower balancing game.  On repeat CT scans, the dislodged gallstone(s) may be seen proceeding distally and impact in the ileum at a level lower than that seen on the previous CT scans, analogous to the tumbling gallstone sign.

We read with great interest the recent article by Umemoto, K. [...].

Introduction  Dysphagia is a significant but underrecognized clinical issue in the intensive care unit (ICU), and it is associated with various complications. Despite its clinical importance, there is limited research and no Greek ICU-specific guidelines for managing dysphagic patients. Additionally, only a few ICUs in Greece have dysphagia specialists, specifically speech-language pathologists (SLPs) providing their expertise. Objective  Τo identify the current practices for dysphagia management (screening, assessment, treatment) and gain insight into ICU directors' awareness/perceptions of the prevalence, complications, and risk of dysphagia. Materials and Methods  We identified 138 Greek ICUs. Data were collected from ICU (including pediatric and neonatal) directors, working in public and private hospitals, via a 24-item, anonymous online questionnaire, within a 4-month period. Results  Our survey was completed by 45 ICU directors. Most participants (84.4%) reported that dysphagia is a relevant clinical problem in their ICU, and 51.1% estimated a frequency rate < 20%. Non-instrumental approaches are mainly utilized to screen and diagnose dysphagia, whereas enteral nutrition and diet modifications are used to manage dysphagia. Additionally, 64.4% of ICU directors agreed that SLPs are essential for the management of dysphagic patients, and 66.7%, that awareness of dysphagia in their ICU could be increased. Conclusion  The current study documented the methods and approaches used to manage dysphagic patients in Greek ICUs. The ICU directors seem to recognize the clinical significance of dysphagia and its complications. According to our findings, the employment of SLPs could result in a more comprehensive and intensive approach and improve the quality of care for these patients., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).)

We explored the regional variations in body composition with advancing age in healthy Caucasian females living in the Mediterranean area. The objectives of this study were to establish body composition values for the trunk in healthy women of a Greek origin and to evaluate the effects of aging on the distribution of truncal bone mass, fat mass (FM) and lean mass (LM). Body composition of the trunk and detailed analysis of its anatomical components-the ribs, the thoracic spine, the lumbar spine and the pelvis, and FM and LM ratios--were calculated in 330 women aged 20-85 years, using DXA. Peak bone mineral density (BMD) of the trunk was attained between ages 30 and 33. The overall truncal BMD reduction with age was 20.7% (p < 0.001). Peak %LM of the trunk was achieved at age 20. The overall reduction of %LM with age for the trunk was 9.8% (p < 0.001). Peak %FM of the trunk was attained between ages 68 and 73, and the overall %FM reduction with age was 2.8% (p > 0.05). Multiple comparative analyses showed that the 51-60 years age group was the landmark age for significant changes of truncal bone mass measures across all age groups (p = 0). For truncal LM and FM metrics, multigroup comparative analysis showed the turning point of significant changes in soft tissue was the 41-50 age bracket (p = 0 and p = 0, respectively). In Greek women, truncal %LM exceeded by far %FM across all ages (p = 0). Our results suggest that aging affects body composition of the trunk in ambulatory healthy women of a Greek origin differently, leading to menopausal loss of bone mass, senior adulthood loss of lean mass, and middle-age storage of fat mass. In adult women, these age-related associations between bone and soft tissue metrics on DXA exams carry implications for the attainment of optimal peak values and shifts in body composition overtime, impacting lifelong skeletal health., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Low-grade fibromyxoid sarcoma and myxofibrosarcoma are malignant soft tissue tumors, fibrosarcomas, of shared clinical and imaging appearances. We report sarcomatous lesions in soft tissue with deceptively benign clinical and imaging appearances, and correlate findings with those of histologic analysis. Two patients presented with a long history of painless swelling at the dorsum and upper extremity and denied any constitutional symptoms. Sonography and magnetic resonance imaging suggested the presence of benign soft tissue lesions of a predominant fluid-like consistency. Despite indolent clinical and imaging characteristics, in both cases, histopathology disclosed a diagnosis of spindle cell-type soft tissue sarcoma, designating an aggressive tumor. Knowledge of the seemingly benign clinical and imaging features of fibrosarcomas is required to raise the possibility of malignancy in soft tissue that may be underdiagnosed or misdiagnosed. The importance of a correct diagnosis and the implications of surgical resection, irradiation, and systemic oncological therapy are quite obvious., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments., Purpose: In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues., Methods: On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema., Results: Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum., Conclusion: Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Theodorou et al.)

Advanced cross-sectional imaging techniques are firmly established as a means of evaluating musculoskeletal disease, and ultrasound (US) is increasingly being used for the assessment of a diversity of tendon, joint, and soft-tissue abnormalities. A benign condition - bizarre parosteal osteochondromatous proliferation (BPOP) - arises from the periosteum, typically in the small bones of the hands and feet, and grows as a surface bone lesion in the surrounding soft tissue. Proliferations can become symptomatic, exercising mass effect on adjacent structures that may require operative management. As a bone-forming process, BPOP may occasionally assume worrisome histologic features that mimic sarcoma, and a pronounced tendency to recur after primary excision. A solitary mass was growing in the middle finger of a young woman that curtailed proper hand function. With US, a partially ossified formation was revealed in the proximal phalanx situated on the outer surface of the bone. There was faint acoustic shadowing distal to the lesion, and a hypoechoic halo was seen covering part of the abnormal tissue growth. Importantly, the lesion caused significant limitation of motion of the finger, on the dynamic flexion US images with the displacement of the flexor tendon and compression of a digital nerve. To restore the range of motion in the finger, surgical excision of the juxtacortical mass was performed and histology yielded a diagnosis of BPOP. We describe the US features of digital BPOP, which were found to correspond closely to those of computed tomography and magnetic resonance imaging., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Medical Ultrasound.)

Skeletal muscle is a major anatomic structural component of the human body. Myopathy, defined as skeletal muscle disease, may offend any of the body's 650 muscles and encompasses an extended array of acute and chronic abnormalities. Muscle disease can be categorized according to etiology as congenital, traumatic, infectious, or neoplastic. The concept of the diversity of multiple muscular disease processes signifies an important role for imaging in the detection and characterization of myopathy. However, despite the exquisite physiological properties of skeletal muscle, muscle imaging has not received attention equal to that of bones and joints. Accordingly, this article provides an indication of the most suitable imaging modalities for myopathy and reviews a multitude of primary and systemic muscle derangements, with an emphasis on magnetic resonance (MR) imaging findings. Because these patterns of MR imaging abnormality bespeak the widespread nature of myopathy, we illustrate typical examples of muscle disease processes to simplify diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Theodorou et al.)

The lumbar intervertebral disc is a complex anatomic structure that can be affected by a number of distinct pathologic processes. Categories of the disease include degenerative changes, subclinical or overt trauma, infectious lesions, inflammatory insults, metabolic disease, and tumors. Abnormalities affecting the intervertebral disc may assume atypical appearances or alterations may as well mimic pathologic processes related to degeneration that can be asymptomatic. Although the imaging findings of degenerative diseases of the vertebral column have been emphasized extensively, the assembly of pathologic conditions associated with the discovertebral segment has not received adequate attention. This manuscript reviews and illustrates a range of abnormalities affecting the discovertebral segment, providing a detailed analysis of postmortem material, in the realm of a close anatomic-imaging correlation. Knowledge of the characteristic morphology and patterns of abnormal conditions affecting the intervertebral disc and discovertebral segment can help radiologists narrow the differential diagnosis in a broad spectrum of disease processes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Theodorou et al.)

The intervertebral disc is designated the most important cartilaginous articulation of the vertebral column that functions to withstand compressive biomechanical forces and confer strength and flexibility to the spine. A thorough study of the complex fine structure and anatomic relationships of the intervertebral disc is essential for the characterization of the integrity of each individual structure in the discovertebral segment. This elaborate work in human cadavers explores the sophisticated internal structure of the normal intervertebral disc and the discovertebral segment, providing detailed data derived from the dissection of specimens through imaging and close anatomic-histologic correlation. Familiarity with the normal appearances and basic functional properties of the lumbar intervertebral disc and discovertebral segment is fundamental for the recognition of aberrations that may have important clinical implications in patients with low back pain. In Part I of this article, the anatomic structure and features of the discovertebral complex in adults will be described., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Theodorou et al.)

Context: Dorsal migration of the sequestered lumbar intervertebral disc is an unusual and underrecognized pattern of lumbar disc herniation associated with pain and neurological deficit. Findings: Three patients presented with lower limb- and low back pain. MR imaging showed intracanalicular mass lesions with compression of the spinal cord and allowed precise localization of lesions in the extradural or intradural space. Diagnosis was straightforward for the patients with the posterior and anterior epidural disc fragments, whereas various differential diagnostic considerations were entertained for the patient with the intradural mass lesion. All patients underwent surgical removal of the sequestered disc fragments, and recovered full motosensory function. Surgical repair of the dura mater due to CSF leak was required for the patient with intradural disc herniation. Conclusion/clinical relevance: Posterior and anterior epidural, and intradural disc migration may manifest with clinical symptoms indistinguishable from those associated with non-sequestered lumbar disc hernias. Missed, migrated disc fragments can be implicated as a cause of low back pain, radiculopathy or cauda equina syndrome, especially in the absence of visible disc herniation. A high index of suspicion needs to be maintained in those cases with unexplained and persistent symptoms and/or no obvious disc herniation on MR images.

Carpal scaphoid fracture is rare in children and is important to recognize early because of an increased risk for serious complications including non-union, avascular necrosis, and osteoarthritis. In the skeletally immature patient, a scaphoid fracture can easily escape detection due to clinical and diagnostic imaging interpretation errors. We report complete healing of a pediatric scaphoid non-union fracture after a remarkable delay in diagnosis and emphasize the considerable biological potential of the immature skeleton, coupled with proper stabilization, for good clinical outcomes., (© 2021. American Society of Emergency Radiology.)

Background: Suction-assisted lipectomy has undergone significant improvements in technique, outcomes, and safety. The local anesthetic option has an excellent safety profile, and energy-based modalities such as radiofrequency-assisted liposuction (RFAL) devices were developed to enhance soft-tissue contraction. The purpose of this study was to report a single center's experience with two surgeons using the second-generation RFAL device compared with the first-generation device in terms of safety and efficacy., Methods: In total, 300 consecutive operations were performed under local anesthesia. Following tumescent injection, the RFAL device was used to heat the skin and underlying collagen network. Subsequently, areas to be contoured were followed with suction-assisted lipectomy to remove excess fat and fluid., Results: An estimated 300 operations were performed on 240 patients in 421 anatomic areas. Treated areas included the face, trunk, and extremities. The average maximum temperatures were 38.6°C externally and 65.6°C internally. The average total and fat aspirate volumes were 1264 and 648 mL. There were no major complications or mortalities, and 3 minor complications treated locally., Conclusions: The data indicated statistically significant lower proportions of major, minor, or cumulative complications compared with the patients who received first-generation RFAL treatment. Major complications were exhibited for 6.25% of the first-generation group and 0% for the second-generation group. The first-generation group exhibited 8.3% minor complications, with 0.7% in the second-generation group. In sum, the data from the second-generation series of RFAL device operations indicate a statistically, as well as clinically, significant reduction in the overall complication rates compared with the first-generation device., Competing Interests: Disclosures: Dr. Chia is consultant and stockholder in InMode Corporation. Dr. Theodorou is consultant and stockholder in InMode Corporation. The other authors have no financial interest to declare., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

OBJECTIVE. The purpose of this article is to review the appearance of various abnormalities that affect the lumbar intervertebral disk and diskovertebral segment through anatomic-pathologic correlation in cadavers. CONCLUSION. Familiarity with the pathologic conditions in and around the intervertebral disk is important in recognizing such conditions as a potential source of symptoms. We revisit the principal role of MRI in evaluating these abnormalities and excluding other sources of significant clinical manifestations.