ACL tear

The anterior cruciate ligament, most commonly known as the ACL, works to stabilize the knee. The ACL can become torn from hyper-extension or rotational trauma to the knee, typically in a sports related injury. This tear in the ACL causes pain, swelling],instability and popping in the affected knee. Diagnosis is typically made with MRI imaging. Surgery is typically required to repair the ACL. This surgery requires the ACL to be removed and replaced by a tendon. This surgery can be done arthroscopically or by opening the knee. The method is determined by the doctor performing the surgery. After surgery phyiscal therapy will be required to regain full use and mobility within the knee.

Labral Tear

The labrum is the cartilage that covers the glenoid of the shoulder. The purpose of the labrum is to hold the head of the humerus in place. There are three different types of tears that can occur. First is typically caused by trauma and that is a complete tear of the labrum from the bone. The second type, seen more often in adults, and is a fraying of the labrum. The third is a tearing of the bicep tendon attachment from the labrum, which is also typically caused by trauma. Diagnosis is most commonly made with MRI or CT arthrogram imaging. If diagnosis cannot be confirmed with imaging, arthroscopic surgery can be done to determine if there is a tear. If the labrum is torn, surgery is the option to treat the tear. The labrum can be trimmed and re-attached. My 16 year old nephew had a posterior labral tear due to multiple sports injuries in which he dislocated his shoulder posteriorly. He had surgery to repair it in October and has healed great with full use of his shoulder again.

Avascular Necrosis

Avascular necrosis is a disease affecting joints, most commonly the hips, where insufficient blood flow to the bone causes death to the bone. Causes of this disease would be trauma to the joint or restriction in blood vessels within the bone. Alcoholism can also cause this disease. Over use of cortisone can be also be a cause. Avascualar necrosis can go undetected for months. MRI is the best type of imaging to diagnose avascular necrosis early. X-rays and bone scans can also be used to diagnose. There is no reversal for avascular necrosis. If caught in early stages, treatment with pain medication and steroid can help treat the pain and prevent further deterioration of the bone. If deterioration is severe, surgery would be the best treatment. There are different types of surgeries depending on the level of deterioration. These surgeries include decompression of the femoral head, bone grafts, and hip replacements. Decompression surgery would drill holes into the femoral head in hope that blood vessels would enter through the new openings and begin bone regeneration. Bone grafts would be placed in the femur and blood vessels attached to create a new path for blood in the hip. Joint replacement is the last treatment, and would be used in severe cases. Included is a MRI image of a hip with avascular necrosis. I have imaged a patient in his late 20's with this disease. To view this type of a disease in someone so young, and appearing to be healthy is scary.

Horseshoe Kidney

Horseshoe kidney is when the two kidneys attach at the lower poles, creating one horseshoe shaped kidney. This is a common type of renal fusion anomaly, occurring more ofter in males. Horseshoe kidneys are not problematic, but because of the anatomical defect, can cause kidney issues. These issues include urinary tract infections, renal stones, renal masses, renal cancer, and
UPJ (ureteropelvic junction) obstructions. Each of these presents it's own type of symptoms and treatments. Horseshoe kidney does not cause these symptoms, and is usually diagnosed while imaging for symptoms of previously listed problems. However, horseshoe kidney does present these problems in a higher percentage of patients than those without horseshoe kidneys.

Thoracic Aortic Aneurysms

Thoracic aortic aneurysms are aneurysms, or increased weakened areas within certain areas of the aorta. To be classified as a thoracic aortic aneurysm it can be located in the ascending, arch, or descending portion of the aorta. Patients with thoracic aortic aneurysms typically experience no symptoms. If they do experience symptoms they could be short of breath or have chest or back pain. When an aneurysm ruptures patients experience severe pain. Many patients die before they even reach a hospital for treatment. Success for treatment of ruptured aortic aneurysms is only about 50 percent. If aneurysms are detected prior to rupture blood pressure can be controlled, and regular checks of the size of the aneurysms are the first steps of treatment. Diagnosis is typically found by accident while imaging another body area, in patients that are having minimal or no symptoms. Resection or grafting can be done to prevent rupturing of the aneurysm, but are typically performed only when the size of the aneurysm has reached certain limits. CT imaging of a thoracic aortic aneurysm can be seen above.

Pars Fracture

Pars fractures, also know as pars defect, are fractures to the area of the vertebrae called the pars. The pars is in the posterior aspect of the vertebrae and connects the lamina and the transverse processes. Trauma or repeat injuries to the low back are what cause pars fractures. They are common in teens, especially gymnasts and football players. Commonly both pars are fractured, but it is possible that only one be fractured. Symptoms are low back pain, stiffness, tingling, numbness and weakness in the lower extremities. Diagnosis can be made in three ways, x-rays, CT scans, and nuclear medicine bone scans. Treatment starts with bracing and restricted activities. It symptoms persist, surgical treatment is necessary. Laminectomy and lumbar fusion are the two types of surgeries performed. A CT sagital image of an L5 pars fracture is shown above.

Thoracic Compression Fractures

Thoracic compression fractures are something that I am very familiar with because one of the radiologists that I work with regularly specializes in treatment of compression fractures. Compression fractures are when the vertebral body breaks and then collapses. This can occur in any vertebral body, but the thoracic spine is the most common area. It is typically caused by some sort of trauma to the spine, but can also be due to osteoporosis. Symptoms are severe back pain and kyphosis. Treatment varies depending on the severity of the fracture. Oral pain medication, bracing, physical therapy, osteoporosis treatment, and surgical procedures are all used as treatment. The surgical procedures are kyphoplasty and vertebroplasty. These surgeries treat the fracture by expanding the vertebral body with a balloon like device and then filling them with a form of hardening material that will work like a vertebral body. Typically other treatments are used along with surgical treatment. Surgery must be performed shortly after the fracture occurs or the body will start to repair the fracture on its own and surgery cannot be performed. Diagnosis is typically made with plain film x-ray but can also be better imaged on CT, and MRI. Included is a CT image of a thoracic compression fracture.