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Biomedical subjects

Carlo Martinoli

Publications and source records attributed to Carlo Martinoli.

At least 19 recordsLinked to original sources
PubMed2006

Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients, a review. Part I: atypical osteoarticular tuberculosis and tuberculous osteomyelitis.

With the resurgence of pulmonary tuberculosis and musculoskeletal tuberculosis in North America and Europe over the last 20 years, the typical pattern of extraspinal musculoskeletal tuberculosis has been changing; presentation of the disease often mimics that of neoplasia. However, certain radiographic features may offer some clues to the more benign nature of the process and its inflammatory and infectious nature. Although the diagnosis of extraspinal musculoskeletal tuberculosis depends largely on clinical context, it is the radiologist's role to guide the imaging workup to initiate the specific treatment as early as possible. As in classic extraspinal tuberculosis, delayed diagnosis may lead to deformity of the involved joint and permanent disability. This review considers atypical osteoarticular tuberculosis and tuberculous osteomyelitis. We discuss examples of these atypical presentations. All patients were permanent residents in Europe and North America, and all were immunocompetent.

Humans↗
PubMed2005

Ultrasound appearance of tendon tears. Part 2: lower extremity and myotendinous tears.

Traumatic tears of the musculotendinous complex at the lower limb are common in clinical practice but can be difficult to detect and to evaluate because of swelling and pain that can limit proper physical examination. They can affect sedentary subjects or active sports participants involved in amateur or professional activities. In the first group tendons are more commonly affected, while myotendinous tears are common in sports players. The aims of this review article are to review the aetiology and pathomechanism of the most common ruptures affecting the tendons and the main myotendinous junctions of the lower extremity and to describe their ultrasound findings as well as to correlate ultrasound appearance with that of the other imaging modalities.

Humans↗
PubMed2005

Imaging findings of spontaneous detachment of the deltoid muscle as a complication of massive rotator cuff tear.

A tear at the origin of the deltoid muscle is uncommon and usually occurs as a complication of shoulder surgery. We report a case of spontaneous deltoid detachment as a complication of massive rotator cuff tear in a 70-year-old woman evaluated by standard radiographs, ultrasound, arthrography and MR-arthrography. We present the multimodality imaging findings with review of the literature. We found that ultrasound is an accurate modality in detecting and assessing spontaneous detachment of the deltoid muscle. As ultrasound is a noninvasive, low-cost, and universally available imaging modality we suggest using ultrasound as the first modality for evaluation of spontaneous detachment of the deltoid muscle.

Aged↗
PubMed2005

Ultrasound of tendon tears. Part 1: general considerations and upper extremity.

The role of ultrasound (US) in assessing musculoskeletal disorders is persistently increasing because of its low cost, readiness, noninvasiveness, and possibility of allowing a dynamic examination. Secondary to increased sport practice, tendon tears are more frequently observed in daily medical practice. They deserve early diagnosis to allow proper treatment that can limit functional impairment. The aim of this review article is twofold: to illustrate the US appearance of normal tendons and to describe the US findings of the most common tendon tears.

Humans↗
PubMed2005

Mild renal dysfunction and renal vascular resistance in primary hypertension.

BACKGROUND: Mild renal dysfunction (MRD) is an often overlooked but relatively common condition in patients with primary hypertension (PH), and is associated with high cardiovascular morbidity and mortality. Whether MRD is also associated with abnormalities in renal vascular resistance is currently unknown. METHODS: Two hundred ninety-one untreated patients with PH were studied. The MRD was defined as a creatinine clearance >or=60 mL/min but <90 mL/min (Cockcroft-Gault formula) or the presence of microalbuminuria. Albuminuria was measured as the albumin-to-creatinine ratio in first morning urine samples. Renal resistive index (RI) was evaluated by ultrasound Doppler of the interlobar arteries. RESULTS: The prevalence of MRD in our cohort was 63%. Patients with MRD were older, had higher mean blood pressure (BP), pulse pressure, and total cholesterol, longer history of hypertension, and were more likely to be men. Renal RI was positively related to female gender, age, systolic BP, pulse pressure, total cholesterol, albuminuria, and to carotid wall thickness and cross-sectional area, whereas it was inversely related to diastolic BP and creatinine clearance. Patients with the highest renal resistance (upper quartile, >or=0.63) showed a greater prevalence of renal dysfunction (P=.0005). After adjusting for age, pulse pressure, and LDL-cholesterol, we found that the risk of MRD increased twofold (P=.04) when renal RI was >or=0.63. CONCLUSIONS: A reduction in creatinine clearance and the presence of microalbuminuria are associated with increased renal vascular impedence, as well as with signs of extrarenal arterial stiffness.

Adult↗
PubMed2005

Ultrasound of the ankle: anatomy of the tendons, bursae, and ligaments.

Ankle tendon and ligament disorders are commonly encountered in everyday orthopedic practice. Whereas tendons can be affected by traumatic, degenerative, and inflammatory conditions, ligaments are mostly involved by tears. Ultrasonography (US) has been accepted worldwide as an efficient, ready, dynamic, and noninvasive tool in assessing ankle tendons and ligaments. The recent technological advances in software and hardware of US equipment have improved the possibilities of US in ankle assessment, and modern equipment allows an accurate depiction of ankle structures. As with all imaging modalities, knowledge of the scanning technique and knowledge of normal US anatomy are prerequisites for a successful examination. In this article we briefly review the normal anatomy of ankle tendons and main ligaments relevant to the US examination. Then we present the routine US technique of examination for the anterior, posterolateral, posteromedial, and posterior region followed by a description of the normal US appearance of tendons, bursae, and ligaments.

Achilles Tendon↗
PubMed2005

Imaging of rock climbing injuries.

Competition climbing has grown increasingly in popularity, and many people are being drawn to this sport with a parallel increase in the occurrence of sport-related injuries. One of the most common and unique lesions occurring in the rock climbing population is the closed rupture of the flexor pulley system of the fingers. This lesion is strictly related to some climbing techniques in which the entire body weight is placed on fingerholds, which causes bowstringing of the flexor tendons with subsequent loss of strength across the full range of motion of the finger. This article summarizes the current literature regarding the application of imaging modalities in the diagnosis of rock climbing injuries with a specific focus on ultrasound and magnetic resonance imaging. Biomechanics of the sporting activity and resultant pathophysiologic and clinical considerations concerning flexor pulley system injuries are also discussed.

Athletic Injuries↗
PubMed2005

Screening mammography interpretation test: more frequent mistakes.

PURPOSE: To present the mammographic cases most commonly misinterpreted by the participants in the mammography self-test proposed by the Italian Society of Medical Radiology (SIRM) National Congress in Rimini, Italy, 2002, by analysing the findings responsible for errors, suggesting reasons for the errors, and assessing possible inadequacies in the format of the test. MATERIALS AND METHODS: The self-test was performed on the mammograms of 160 cases (32 positive and 128 negative for cancer as confirmed by histology). The mammograms had been taken in the four standard projections and placed on four multi-panel diaphanoscopes, each displaying a set of 40 cases comprising benign and malignant cases in equal proportions. The participants were given pre-printed forms on which to note down their diagnostic judgement. We evaluated a total of 134 fully-completed forms. Among these, we identified the 23 cases most frequently misread by over 15 participants in percentages varying between 40-90%. Of these cases, 10 were malignancies and 13 were negative mammograms. On review, we also assessed the diagnostic contribution of complementary investigations (not available the participants). RESULTS: The 134 fully-completed forms (all of the 40 cases) yielded a total of 5360 responses, 1180 of which (22.01%) were incorrect. Of these, 823 out of the 4288 cases expected to be negative (19.2%) were false positive, and 357 out of the 1072 cases expected to be positive (33.3%) were false negative. As regards the 23 most frequently misread cases, these were 10/32 (31.25%) mammograms positive for malignancy and 13/128 (10.15%) negative mammograms or mammograms showing benign disease. The 10 malignancies included 7 infiltrating ductal carcinomas, 1 infiltrating cribriform carcinoma, 1 infiltrating tubular carcinoma, and 1 carcinoma in situ. The 13 cases of benign disease--as established by histology or long-term follow-up--mistaken for malignancies by the test participants were fibrocystic breast disease in 5 cases, surgical scar in 1 case, ABBI scar in 1 case, radial scar in 2 cases, microcalcifications that had remained stable for years in 2 cases, focal sclero-adenosis in 1 case and sclero-elastosis in 1 case. CONCLUSIONS: The errors were due to microcalcifications, benign disease simulating a neoplasm, overlapping tissue, visibility of a lesion in one projection only, lesion site in relation to the corpus mammae, missed areas of asymmetry. Attention must be paid to these signs of focal breast disease since, if correctly evaluated, they enable the early diagnosis of low-grade carcinomas that frequently carry a favourable prognosis.

Adenocarcinoma↗
PubMed2003

Ultrasound diagnosis of anterior iliopsoas impingement in total hip replacement.

Iliopsoas impingement syndrome, an infrequent complication of total hip replacement, has been rarely reported in the radiological literature. It follows chronic friction of the posterior aspect of the iliopsoas muscle and tendon against the acetabular cup, a piece of cement, or cup fixation screws. Clinical findings are non-specific and an imaging modality is required to diagnose the condition. Computed tomography (CT) is considered the gold standard imaging modality in evaluating iliopsoas impingement. We report a case of a patient in which the diagnosis was made by ultrasound and later confirmed by CT.

Aged↗
PubMed2003

Sonographic evaluation of brachial plexus pathology.

Pre-operative US examinations of the brachial plexus were performed with the purpose of exploring the potential of this technique in recognizing lesions in the region and defining their sonographic morphology, site, extent, and relations to adjacent anatomic structures, and comparing them to the surgical findings to obtain maximal confirmation. Twenty-eight patients with clinical, electro-conductive, and imaging findings suggestive of brachial plexus pathology were included in this study. There were four main etiology groups: post-traumatic brachial plexopathies; primary tumors (benign and malignant); secondary tumors; and post irradiation injuries. Twenty-one of the 28 patients underwent surgery. Advanced imaging (mostly MRI) served as an alternative gold standard for confirmation of the findings in the non-surgically treated group of patients. The US examinations were performed with conventional US units operating at 5- to 10-MHz frequencies. The nerves were initially localized at the level of the vertebral foramina and then were followed longitudinally and axially down to the axillary region. Abnormal US findings were detected in 20 of 28 patients. Disruption of nerve continuity and focal scar tissue masses were the principal findings in the post-traumatic cases. Focal masses within a nerve or adjacent to it and diffuse thickening of the nerve were the findings in primary and secondary tumors. Post-irradiation changes presented as nerve thickening. Color Doppler was useful in detecting internal vascularization within masses and relation of a mass to adjacent vessels. The eight sonographically negative cases consisted either of traumatic neuromas smaller than 12 mm in size and located in relatively small branches of posterior location or due to fibrotic changes of diffuse nature. Sonography succeeded in depicting a spectrum of lesions of traumatic, neoplastic, and inflammatory nature in the brachial plexus. It provided useful information regarding the lesion site, extent, and anatomic relationships; thus, the principal aims of the study were therefore met. Once the technique of examination is mastered, sonography should be recommended as part of the pre-operative evaluation process post-ganglionic brachial plexus pathology. Most disadvantages are related to the restricted field of view and inability to overcome bonny obstacles particularly in evaluating pre-ganglionic region. As sonography is frequently employed for investigation of the supraclavicular region, awareness of the radiologist to the findings described may enable the early recognition of pathologies involving or threatening to involve the brachial plexus.

Adult↗
PubMed2003

Imaging of fractures of the lateral process of the talus, a frequently missed diagnosis.

Although if fractures of the lateral process of the talus (LPT) have been considered rare the widespread diffusion in snowboard practice has resulted in a dramatic increase in their frequency. If unrecognized they can result in secondary osteoarthritis of the ankle and/or talo-calcaneal joints and chronic pain and stiffness. Due to the complex anatomy of the region, these fractures are difficult to detect by standard radiographs. A high degree of suspicion is then necessary to diagnose them. Once suspected on the basis of physical examination and/or non concluding radiographs, computed tomography (CT) is the best modality to confirm the diagnosis and accurately appreciate the number of the fragments and their position which have therapeutic consequences (medical vs. surgical treatment). A better knowledge of these lesions seems necessary to the general radiologist to allow an early diagnosis in order to avoid chronic sequel. The purpose of this article is to report three additional cases of LPT fractures and discuss their pathogenesis, diagnosis and treatment.

Adult↗
PubMed2003

Sonographic diagnosis of talar lateral process fracture.

The frequency of fractures of the lateral process of the talus (LPT) has markedly increased because of the expansion of snowboard activity. These lesions are difficult to diagnose, because they have aspecific signs, and standard radiographs do not show the fractures in 50% of cases. Sonography is used more and more in the assessment of ankle trauma, but it is rarely performed for detection of bone fractures. We report a case of a patient in which sonography directly showed an LPT fracture.

Adult↗
PubMed2002

Central aponeurosis tears of the rectus femoris: sonographic findings.

OBJECTIVE: The purpose of this study was to review the normal and sonographic (US) anatomy of the central aponeurosis of the rectus femoris muscle, describe the sonographic appearance of its tears and correlate it with the MR findings. DESIGN AND PATIENTS: The rectus femoris internal architecture was evaluated by cadaveric dissection. To correlate the sonographic normal findings with cadaveric data, axial sections were compared with the corresponding US images. The normal in vivo sonographic appearance of rectus femoris was assessed in 20 healthy subjects (40 thighs). To evaluate the US findings in central aponeurosis tears we performed a retrospective review of 17 examinations of 17 patients suffering from acute injuries. Follow-up examinations were available in five patients. Sonographic findings were correlated with MR findings in eight patients. RESULTS: Anatomical dissection of the rectus femoris confirmed the presence of the central aponeurosis, a sagittally oriented fibrous band located within the proximal two-thirds of the muscle belly. In vitro US showed the central aponeurosis as a curvilinear hyperechoic structure whose shape correlated well with the cadaveric data, and in vivo US demonstrated it in all healthy subjects. In the retrospective analysis of the patient group, we classified the lesions into three groups according to the size at sonography: group 1 ( n=9), hyperechoic band surrounding an intact central aponeurosis; group 2 ( n=7), mixed hypo- and hyperechoic bands surrounding an intact central aponeurosis but associated with globular enlargement of the rectus femoris; group 3 ( n=1), complete discontinuity of the rectus femoris. These findings can reflect small partial tears, larger partial tears and complete musculotendonous junction tears respectively. In patients evaluated with both techniques, MRI confirmed the US findings. In five patients follow-up studies showed an irregular hyperechoic ill-defined area centred on the central aponeurosis that was compatible with a central scar. CONCLUSIONS: Sonography can demonstrate the normal internal anatomy of the rectus femoris and post-traumatic changes at the myotendinous junction of the central aponeurosis. Sonographic data correlate well with MR findings, and the low cost and wide availability of sonography make it the first-line technique in the evaluation of injuries of the rectus femoris.

Adult↗
PubMed2002

Color Doppler appearance of penile cavernosal-spongiosal communications in patients with severe Peyronie's disease.

Our objective was to investigate the prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC) in patients with severe Peyronie's disease. These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Twenty patients with severe Peyronie's disease underwent penile color Doppler US after intracavernous injection of prostaglandin E(1). Study inclusion criteria were penile curvature or shortening which made intercourse difficult or impossible. The quality of erectile response was subjectively scored. The spectral characteristics of CSC were evaluated in comparison with waveform changes in cavernosal artery. There were 4 patients with normal erectile response, 10 with discrepancy in rigidity of the penile base and tip, 4 with veno-occlusive dysfunction and 2 with arteriogenic dysfunction. The CSC just proximal to the plaques had peak systolic velocity (PSV) significantly higher and resistance index (RI) significantly lower than the other CSC. The PSV in CSC near the plaques of patients with base-tip discrepancy and with veno-occlusive dysfunction were significantly higher than in the other patients. In patients with severe Peyronie's disease CSC near the plaques remain patent with low-resistance flow supporting the hypothesis that blood leakage can occur through these vessels.

Adult↗
PubMed2002

Color Doppler appearance of penile cavernosal-spongiosal communications in patients with normal and impaired erection.

Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC). These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency, and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries in all patients and increased during phases 1-2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients with normal and impaired erection.

Humans↗
PubMed2002

Sonographic and MRI appearance of tensor fasciae suralis muscle, an uncommon cause of popliteal swelling.

A 20-year-old white man presented with a localized unilateral swelling in the popliteal fossa. Ultrasound (US) showed the presence of an accessory muscle, the tensor fasciae suralis. The muscle was located in the proximal portion of the popliteal fossa, superficial to the medial head of the gastrocnemius. Its long tendon extended inferiorly to join the Achilles tendon. Magnetic resonance images correlated well with the US findings, confirming the diagnosis. Tensor fasciae suralis muscle is a rare cause of popliteal swelling and must be differentiated from other masses. Both US and magnetic resonance imaging can diagnose it but we suggest US as the first-line technique in its evaluation.

Adult↗
PubMed2002

Giant iliopsoas bursitis: sonographic findings with magnetic resonance correlations.

We present the case of a 40-year-old man with rheumatoid arthritis who had a painless left inguinal mass. Sonographic examination revealed a large soft tissue mass with mixed internal echotexture and regular borders extending inside the pelvis and into the proximal portion of the thigh. Sonography also showed communication between the bursa of the iliopsoas muscle and the hip cavity, with intra-articular synovitis and erosion of the ileum. Giant iliopsoas bursitis secondary to hip involvement in rheumatoid arthritis was diagnosed on the basis of the sonographic findings. This diagnosis was confirmed by MRI.

Adult↗