A 14 year old male presented with a palpable, growing bump on the dorsal aspect of his left thumb since 1 year prior. Radiographs showed a large soft tissue mass dorsal to the interphalangeal joint of the left thumb with extension into the proximal phalanx. Contrast-enhanced MRI demonstrated the mass as mildly lobular and T2/STIR hyperintense, with internal septations and nodular wall enhancement. The lesion was biopsied and excised. Final pathology results revealed an extraneural (soft tissue) perineurioma. Perineuriomas are very rare, usually benign peripheral nerve neoplasms composed of perineural cells. Because of the rarity of these lesions, advanced imaging with MRI becomes a useful tool in diagnosis, extent of disease, and surgical planning. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Wei Xin, Thapa Mahesh, Reed Robyn

Keywords: perineurioma, perineuriomas, extraneural

The purpose of this educational presentation is to demonstrate ultrasound technique and characteristic sonographic findings of common superficial pediatric extremity soft tissue lesions. We also offer advice on how to differentiate benign from malignant lestions. Children frequently present with unexplained “lumps and bumps” on their extremities. These lesions are often invisible on radiography; MRI might require use of sedation; and CT exposes the child to radiation and often requires iodinated contrast. Ultrasound (US) is a cost-effective, radiation-free, and dynamic method to evaluate superficial soft tissue lesions. We discuss choice of transducer based on lesion location. We explain why a multifrequency transducer, which allows for the evaluation of both superficial (higher frequency spectrum of the transducer) and deeper (lower frequency spectrum of the transducer) components of the lesion is important. The use of compound imaging is explained, as multiple angles of insonation are combined to provide a more complete image of the structure being interrogated. For lesions involving the hands or feet, we explain the water-bath technique. Water is an excellent medium for ultrasound waves and will minimize artifacts from air and inadequate surface contact that plague evaluation of the distal extremities. We then discuss characteristic sonographic appearance of the following conditions: vascular anomalies, osteomyelitis and subperiosteal abscess, hematoma, subcutaneous granuloma annulare, Pilomatricoma, lipoma, ganglion and Baker cyst, muscle hernia, osteochondroma, foreign bodies, and malignant conditions. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Thapa Mahesh, Ojeda Patricia, Otjen Jeffrey, Ngo Anh-vu, Callahan Michael

Keywords: ultrasound, benigh, malignant

The purpose of this educational exhibit is to demonstrate the lower extermity manifestations of Cerebral Palsy (CP). The focus will be on plain radiographic findings, along with surgical approaches to the various abnormalities. Conditions presented will include the following: equinus, equinocavovarus, equinoplanovalgus, oblique talus, vertical talus, ankle valgus and hallux valgus. In addition, a thorough and systematic approach on how to evaluate pediatric foot abnormalities will also be discussed. CP is caused by abnormalities of the developing fetal or infant brain that result in permanent central motor dysfunction. The prevalence of CP is about 2 in 1000 live births. Although this is higher in pre-term and low birthweight infants. The proposed underlying causes are many and include infection, hypoxia, structural changes, ischemia, and hemorrhage. The underying neural damage is nonprogressive, but the clinical manifestations can change and magnify. Gross Motor Function Classification System (GMFCS) is used to grade the severity of disease. Affecting about 93% of patients with CP, foot and ankle deformities have a huge impact on patient ambulation and GMFCS score. Such lower extremity abnormalities are classified using three “levels” of severity which influnce treatment options. Level I is mild, flexible deformity; level II manifests as soft tissue contracture; and level III causes skeletal remodeling and bony deformity. Only by apprecaiting the clinical and radiological manifestations of CP can we attain a more thorough understanding of the condition and its multitude of presentations. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Thapa Mahesh, Maloney Ezekiel, Menashe Sarah, Otjen Jeffrey, Ngo Anh-vu, Iyer Ramesh

Keywords: Cerebral Palsy, equinus, cavus