Tendinous Portion Research Articles

Resection of the Proximal Tendinous Portion in Avulsion of the Semimembranosus Tendon from the Ischial Tuberosity in an Adult: A Case Report

Hamstrings are composed of the semimembranosus and semitendinosus and biceps femoris muscles and act as extensors of the thigh and flexors of the leg. Avulsion of the hamstring from the ischial tuberosity has a high rate of incidence among adolescents and young adults, and most often results from exercises that require sudden acceleration and deceleration, such as running, soccer, hurdling and basketball. This injury, caused by forcible flexion of the hip with the knee extended, is commonly called hurdlers' injury. There have been several reports describing treatment of hamstring proximal tendon avulsion injury by open reduction and internal fixation. We describe a case of semimembranosus tendon avulsion from the ischial tuberosity in the adult that was satisfactorily treated by resection of the proximal portion of the tendon.

Transposition of the esophageal hiatus: a useful addition to Belsey repair of hiatus hernia

A novel method of hiatus hernia repair is presented in the course of which a 4-6 cm incision is made into tendinous portion of the diaphragm beginning at the esophagus hiatus and carried into the anterolateral direction. This allows the mobilized esophagus to be displaced anteriorly. A classic Belsey-procedure is done after which, not only the crura, but also part of the tendinous part of the diaphragm are united posteriorly making recurrence less likely.

Immunohistochemistry of the enthesis organ of the human Achilles tendon.

The insertional region of the Achilles tendon includes: the fibrocartilage of the enthesis at the tendon-bone junction, the sesamoid fibrocartilage in the deep surface of the tendon, and the periosteal fibrocartilage covering the superior tuberosity of the calcaneus. The mechanism by which compressive stress and low oxygen concentration modulate the phenotypical expression of cartilaginous cells in mesenchymal tissue is still unknown. Tenascin-C isoform, with its anti-adhesive properties, has been hypothesized to have a role in cellular adaptation to compression. The purpose of this study was to define the immunohistochemical localization of tenascin-C in the enthesis organ of the Achilles insertion in man. Five specimens of Achilles tendon and its insertion were obtained from adult patients during below-knee amputation surgery. To determine the histochemistry, for light microscopy, specimens were stained with hematoxylin-eosin, safranin-O, Verhoeff, alcian blue methods. For immunohistochemistry, the following antibodies were used: anti-S-100 protein; anti-chondroitin sulfate; anti-types I and II collagen, anti-type IV collagen, anti-type X collagen, and anti-tenascin-C. The enthesis, sesamoid, and periosteal fibrocartilages have been defined by a separate region of immunohistochemical labeling for S-100 antibody and type II collagen and chondroitin-sulfate. The sesamoid and periosteal fibrocartilages stained for tenascin-C, which in cartilaginous areas was closely associated with rounded cells in the extracellular matrix. By showing a relationship between chondrocyte-like cells and immunolabeling for tenascin-C in periosteal and sesamoid fibrocartilage, the present data suggest a role in the dynamic equilibrium in the formation of fibrocartilaginous foci in tendon areas exposed to compressive stress. The data support the surgical practice of the resection of the diseased tendinous portion in case of chronic Achilles tendinitis. The decompression removed the enthesis organ that in an inflammatory environment could be altered and would not contribute to the distribution of the tensive load. After the decompression, it was hypothesized that in tendon areas exposed to compressive stress there was restoration of the fibrocartilaginous foci that constitute the enthesis organ.

Endometriosis-related pneumothorax: clinicopathologic observations from a newly diagnosed case

thymic masses by indium-111-DTPA-D-pentetreotide scintigraphy. J Nucl Med. 1998;39:634-9. 22. Reisiene T, Bell GI. Molecular biology of somatostatin receptors. Endocr Rev. 1995;16:427-42. 23. Patel YC, Srikant CB. Subtype selectivity of peptide analogs for all five cloned human somatostatin receptors (hsstr 1-5). Endocrinolgy. 1994;135:2814-7. 24. Filosso PL, Ruffini E, Oliaro A, Papalia E, Donati G, Rena O. Long-term survival of atypical bronchial carcinoids with liver metastases, treated with octreotide. Eur J Cardiothorac Surg. 2002;21: 913-7.

The changes in mechanical properties of regenerated and residual tissues in the patellar tendon after removal of its central portion

Objective. To know the temporal changes of the mechanical properties of the regenerated and the residual tissues in the patellar tendon after removal of the central portion. Design. The regenerated and the residual tissues were compared to sham-operated tendons. Background. Although the structural properties of the whole patellar tendon after removal of the central portion have been investigated, no studies have distinguished between the regenerated and the residual tissues. Methods. For 52 skeletally mature rabbits, a full-thick, segmental defect was made at the central portion of the right patellar tendon, while a sham operation performed in the left tendon. At 3, 6, 12, and 24 weeks, we evaluated the mechanical properties and fibroblast density of the regenerated and the residual tissues as well as the blood flow and tissue dimensions of the patellar tendon. In addition, non-treated patellar tendons from six rabbits were served as the control for mechanical testing. Results. The tangent modulus and the tensile strength of the regenerated tissue progressively increased with time. On the other hand, these parameters of the residual tendinous portion decreased until 6 weeks, although they gradually increased thereafter. The tensile strength of the regenerated and the residual tissues at 24 weeks were approximately 80% and 75%, respectively, of the non-treated, control tendon. Abundant blood flow and cell proliferation were observed in the regenerative tissue until 6 weeks. Conclusion. The mechanical properties of the regenerated and the residual tissues after removal of the central portion in the patellar tendon are much different from those of the original tendon. Relevance The present study showed inferior mechanical properties of the residual and the regenerated tissues for up to 24 weeks after removal of the central portion in the patellar tendon. Therefore, the aggressive rehabilitation that applies excessive load to the patellar tendon should be avoided at an early stage after harvesting the tendon for ligament reconstruction.

The Natural History of Stab Wounds of the Diaphragm: Implications for a New Management Scheme for Patients with Penetrating Thoracoabdominal Trauma

For most patients with abdominal stab wounds expectant management has become the norm. Thoracoabdominal stab wounds, however, raise concern about possible diaphragmatic injury, and diagnostic minilaparotomy, laparoscopy, or thoracoscopy have been advocated in such patients. The present study examined the natural course of an untreated diaphragmatic stab wound. With Institutional Review Board approval eight 25- to 30-kg anesthetized pigs underwent a small upper-midline laparotomy. A 1.5- to 2-cm incision was made in each diaphragm-in the muscular portion on one side and in the tendinous area on the other side. Thereafter a 12-F catheter was placed into each thoracic cavity and attached to suction to resolve pneumothoraces. The laparotomy incision was closed, and the thoracic catheters were removed. Six weeks later the animals were reanesthetized, and the diaphragmatic stab wounds were examined at laparotomy. Fifteen of the 16 (93.8 per cent) diaphragmatic wounds were completely healed. All eight stab wounds in the muscular portion of either diaphragm healed spontaneously. In one animal there was a persistent defect in the tendinous portion of the left diaphragm at the site of the stab wound. The tip of the left lateral segment of the liver and the superior pole of the spleen were found in the defect at laparotomy. We conclude that the vast majority of stab wounds to either the muscular or tendinous diaphragm heal spontaneously. Thus invasive procedures to assess the status of the diaphragm in all patients with thoracoabdominal stab wounds is unwarranted.

Toracoscopia em eqüinos: estudo comparativo entre duas técnicas de abordagem

A toracoscopia tem sido cada vez mais indicada como exame auxiliar para diagnóstico das diversas afecções do tórax. Com o objetivo de comparar duas técnicas de abordagem para inspeção da cavidade pleural, foram utilizados 16 animais hígidos, que foram submetidos à toracoscopia, dos quais dez sob anestesia geral com intubação orobronquial seletiva e seis em posição quadrupedal sob sedação associada à anestesia local. Foram abordados os hemitórax direito e esquerdo, com intervalo de 15 dias entre cada procedimento. Durante a abordagem, pôde-se observar as diversas estruturas da cavidade torácica, a saber: músculo diafragma (porção muscular e tendínea), hiato esofágico, mediastino, artéria aorta, troncos dorsal e ventral do nervo vago, ducto torácico, veia ázigos, veias intercostais, músculos intercostais, costelas, tronco nervoso simpático, tronco vascular toracocervical, traquéia, pulmão (lobo cranial e caudal), esôfago, pericárdio, veia cava caudal, nervo frênico, linfonodos aórticos. A realização do exame toracoscópico com os animais sedados e mantidos em posição quadrupedal possibilitou a identificação de um maior número de estruturas. A toracoscopia mostrou ser exame de grande auxilio, pela facilidade e rapidez de execução e ampla inspeção da cavidade pleural, mas a escolha de posicionamento do animal irá depender do órgão ou estrutura a ser preferencialmente abordada. Nos casos em que se optar pelo decúbito, há que se considerar o emprego da ventilação mecânica com intubação orobronquial seletiva.

Length and width of the tendinous portion of the palmaris longus: a cadaver study of adult Japanese.

We examined 72 forearms of 36 cadavers to measure the length and width of the tendinous portion of the palmaris longus in adult Japanese. The palmaris longus muscles were absent in both arms in 1 cadaver and in a unilateral arm in 1 cadaver. Double palmaris longus muscles were found in 1 arm in another cadaver. Most cadavers had a typical palmaris longus muscle and tendon shape. The mean length and width of the tendons were 124.6 +/- 17.0 and 4.5 +/- 0.7 mm, respectively, in male specimens and 108.3 +/- 16.4 and 4.0 +/- 0.7 mm in female specimens, respectively. The mean lengths of the forearms were 240.0 +/- 12.6 mm in male specimens and 218.8 +/- 14.6 mm in female specimens. There was a statistically significant correlation between the lengths of the palmaris longus tendon and forearm. These results indicate that one can estimate the length of palmaris longus tendons before surgical intervention.

An anatomic study of the supraspinatus muscle and tendon.

The gross and histologic anatomy of the myotendinous portion of the supraspinatus muscle was investigated with coronal and sagittal sections from 20 anatomic specimen shoulders. The anterior lateral portion of the supraspinatus contained more tendon than the posterior portion of the muscle in all 20 specimens. In seven specimens there were separate muscle fibers that originated from the most anteromedial area of the supraspinatus fossa. Knowledge of this anatomy aids in magnetic resonance image interpretation and open or arthroscopic evaluation of the supraspinatus. This consistent tendinous portion may be useful in rotator cuff repair and may provide a firm area for suture closure of the rotator interval. This prominent anterior tendinous area may serve to protect the supraspinatus during anterior forward flexion motion through the impingement arc.

DIAPHRAGMATIC HERNIA ASSOCIATED WITH ADULT POLYCYSTIC KIDNEY DISEASE

Traumatic rupture of the diaphragm may result from penetrating or blunt trauma to the abdomen or chest. The tendinous portion, especially on the left side, is the usual site of laceration in long-term survivors. On the other hand, congenital hernias result from the maldevelopment of the septum transversum and may cause defects anteriorly, such as parasternal hernia of Morgagni, posterior hernia of Bochdalech or central tendon hernia. We report on a patient with delayed presentation of a right diaphragmatic hernia after sustaining injuries in a motor vehicle accident 20 years previously. Herniation of the abdominal viscera into the right hemithorax was complicated by progressive expansion of bilateral polycystic kidneys.

Rupture of the Achilles tendon.

Achilles, the warrior and hero of Homer's Iliad, lends his name to the Achilles tendon, the thickest and strongest tendon in the human body138. Thetis, Achilles's mother, made him invulnerable to physical harm by immersing him in the river Styx after learning of a prophecy that Achilles would die in battle. However, the heel by which he was held remained untouched by the water and thus Achilles had a vulnerable point. Achilles led the Greek military forces, which captured and destroyed Troy after killing the Trojan prince Hector. However, Hector's brother Paris killed Achilles by firing a poisoned arrow into his heel164. Hippocrates, in the first recorded description of an injury to the Achilles tendon, stated that “this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death.”26 Ambroise Pare, in 1575, recommended that a ruptured Achilles tendon be strapped with bandages dipped in wine and spices, but advised that the result was dubious27. Operative repair of a ruptured Achilles tendon was advocated in 1888 by another Frenchman, Gustave Polaillon27, although an Arabian physician performed such procedures as early as the tenth century A.D. In the twelfth century, an Italian surgeon, Guglielmo di Faliceto, believed that nature was unable to unite divided tendons and that operative treatment was necessary27. Much research has been performed to elucidate the etiology of a rupture of the Achilles tendon, but its true nature still remains unclear190. Also, the best method of treatment is still fiercely debated. Some physicians advocate operative repair, whereas others insist that an operation is unnecessary and poses an unacceptable risk. The tendinous portions of the gastrocnemius and soleus muscles merge to form the Achilles tendon. The plantaris …

Three-dimensional magnetic resonance imaging of the interosseous membrane of forearm: a new method using fuzzy reasoning

We now report newly developed three-dimensional magnetic resonance imaging (3D-MRI) system which is based on semiautomatic tissue extraction from the axial MR images utilizing the fuzzy reasoning calculation method and 3D-image reconstruction with surface rendering. We also studied normal in vivo dynamic changes of the interosseous membrane (IOM) of forearm during rotation using this 3D-MRI. Serial axial MRI of right forearms of five healthy volunteers was obtained in five rotational positions, and extraction and 3D-reconstruction of the radius, ulna, and IOM was made using the system. Extraction results were well with the fuzzy reasoning method. 3D-MRI of the radius and ulna, IOM were reconstructed from these images respectively, and their 3D-shapes were almost identical to the anatomic shape. 3D-MRI showed there were wavy deformities on the IOM in pronation position in the all five subjects and dorsiflexion on the most dorsal portion of the IOM at maximum supination in three forearms. In neutral position, the IOM of all five volunteers was almost flat. From anatomic orientation, these dynamic changes of the IOM mainly occurred at the membranous portion, which is soft, thin, and elastic. Otherwise, the tendinous portion which is a thick and strong complex of 5 to 10 bundles run from proximal one third of the radius to distal one fourth of the ulna, demonstrated minimal dynamic changes on the 3D-MRI. Therefore, the tendinous portion is considered to be taut during rotation to provide stability between the radius and the ulna, while the membranous portion is easy to deform and allowing smooth rotation. Furthermore, because of wide-use, our 3D-MRI system is useful for in vivo analysis of soft tissue kinesiology in normal and abnormal musculoskeletal systems.

The Lymphatic Vessels and the So-Called “Lymphatic Stomata” of the Diaphragm: A Morphologic Ultrastructural and Three-Dimensional Study

We studied the absorbing peripheral lymphatic vessel with the light microscope, the transmission electron microscope, the scanning electron microscope, and three-dimensional models of the diaphragm of several rodents and insectivores under normal and experimental conditions (lymphatic stasis and dehydration). To clarify the delicate and complex mechanism that permits drainage of the abdominal cavity contents into the lymphatic circulatory system, we introduced Polystyrene latex spherules, China ink, and Trypan blue into the abdominal cavities. After anatomical comparisons of the superficial and deep networks of absorbing peripheral lymphatic vessels at the tendinous and muscular portions of the diaphragm and after classification of lymphatic vessels into absorbing and conducting functions, we examined the stomata, which, owing to morphologic and topographic findings, we defined as stable structures. Furthermore, we observed that the stomata and submesothelial connective channel are fundamental elements that facilitate the flow of the corpuscular and liquid contents of the peritoneal cavity to the submesothelial absorbing lymphatic vessel wall. Also, we underlined that the genesis of the connective channel depends on the secondary cytoplasm extensions of two distinct adjacent endothelial cells, which, to facilitate the flow of the absorbed abdominal contents, completely coat this channel. Additionally, our observations illustrate that the secondary cytoplasm extensions do not engage in continuous relationships with the basal lamina of the mesothelium and with the margins of the stoma, and, hence, the hypothesis of “lymphatic stomata” as an expression of the anchoring of the borders of the open interendothelial junctions to the orifice margins of the stoma cannot be confirmed. Moreover, we describe the presence and formation of intraendothelial channels in the lymphatic endothelial wall. We affirm that this morphological entity is a dynamic unit, because its numerical density varies according to different physiological and experimental conditions to degrees of hydrostatic and colloidal osmotic pressure and, perhaps, also to the particular characteristics of the substances that the connective channel liberates into the endothelial wall of the lymphatic vessel. In conclusion, we affirm that the absorbing peripheral lymphatic vessels of the diaphragm, by way of intraendothelial channel formations, membrane diffusion, and the vesicular path of the endothelial cells, constitute the fundamental draining elements for the corpuscular and liquid contents of the abdominal cavity.

Reflex inhibition of canine inspiratory intercostals by diaphragmatic tension receptors.

1. Electrical stimulation of phrenic afferent fibres in the dog elicits a reflex inhibition of efferent activity to the inspiratory intercostal muscles. However, electrical stimulation has a poor selectivity, so the sensory receptors responsible for this inhibition were not identified. 2. In the present studies, cranial forces were applied during spontaneous inspiration to the abdominal surface of the central, tendinous portion of the canine diaphragm to activate tension mechanoreceptors in the muscle. Vagal afferent inputs were eliminated by vagotomy. 3. The application of force to the central tendon caused a graded, reflex reduction in inspiratory intercostal activity, especially in external intercostal activity. This reduction was commonly associated with a decrease in inspiratory duration and was invariably attenuated after section of the cervical dorsal roots. 4. In contrast, no change in inspiratory intercostal activity was seen when high frequency mechanical vibration was applied to the central tendon to stimulate diaphragmatic muscle spindles. 5. These observations provide strong evidence that tension receptors in the diaphragm, but not muscle spindles, induce reflex inhibition of inspiratory intercostal activity. The expression of this reflex probably involves supraspinal structures.

Enthesopathy of the radial tuberosity in two thoroughbred racehorses

Two cases of enthesopathy of the radial tuberosity in Thoroughbred racehorses are described. Soft X-ray pictures revealed separated bony fragments at the anterior aspect of the radial tuberosity, resembling the lesions of Osgood-Schlatter disease in children. Osgood-Schlatter lesions result from detachment of a portion of the apophysis of the tibial tuberosity. However, in the affected horses, the detached bony fragments consisted of cortical bone tissue composed of trabeculae with osteons similar to lamellar bone, the main component of the radial tuberosity. Tendon fibrils were inserted into the anterior parts of the detached fragments, and scar tissue filled the gap between the posterior part of the fragments and the radial tuberosity. The bone fragments may have originated from an avulsion fracture at the site of attachment of the tendinous portion of the biceps brachii muscle to the bone tissue of the radial tuberosity, a site at which high-tensile force is repeatedly exerted by muscle contraction.

Diagnostic efficacy of ultrasonography in stage I posterior tibial tendon dysfunction: sonographic-surgical correlation.

The purpose of this study is to evaluate the diagnostic efficacy of ultrasonography in stage I posterior tibial tendon dysfunction. Fourteen of the 17 consecutive patients who underwent tenosynovectomy for stage I posterior tibial tendon dysfunction were included in this study. The preoperative diagnosis was based primarily on the clinical suspicion of dysfunction, which was confirmed by ultrasonography. Two measurements were obtained at the midpoint between the insertion site and the medial malleolus in both feet of the 14 patients: the diameter of the posterior tibial tendon and the diameter of the tendon sheath measured from its inner walls. The mean diameter of the tendon was 4.61 +/- 0.50 mm and that of the tendon sheath in the symptomatic foot was 7.24 +/- 0.75. In the unaffected foot, the mean diameter of the tendon was 3.30 +/- 0.34 mm and that of the tendon sheath was 3.64 +/- 0.35 mm, respectively. In the symptomatic tendon, the increase of peritendinous space was significantly higher than the increase in the tendinous portion (P < 0.0001). Surgical findings proved the accuracy of diagnosis in all patients. Although many cases of stage I posterior tibial tendon dysfunction remain undiagnosed owing to the mild clinical symptoms, this series indicates that ultrasonography is a valuable adjunctive diagnostic tool in the clinical examination and assists in achieving an accurate diagnosis of stage I posterior tibial tendon dysfunction, allowing early treatment.

A study of the three-dimensional organization of the human diaphragmatic lymphatic lacunae and lymphatic drainage units

The peritoneal stomata, lymphatic drainage units and subperitoneal terminal lymphatics, called lymphatic lacunae, form a specialized drainage system in the diaphragm, by which absorption of fluid in bulk, particles and cells is carried out in the peritoneal cavity. The aim of this study is to elucidate the three-dimensional organization and function of the subperitoneal lymphatic lacunae and lymphatic drainage units by using lymphatic casts in the scanning electron microscope (SEM), ODO (OsO4-DMSO-OsO4) freeze fracture, conventional SEM and the transmission electron microscope (TEM). The subperitoneal lymphatic lacuna is unique for its large size and its multiple morphology and can be recognized by its broad, flattened enlargement and the blind-ends of lymphatic vessels, from which extend numerous main lymphatic vessels and side branches. These lymphatic vessels communicate with each other and form a rich lymphatic plexus under the diaphragmatic peritoneum. Two layers of lymphatic networks, i.e. the subperitoneal plexus and the deeper plexus are found in the muscular portion. Only one layer is present in the tendinous portion of the human diaphragm. The lymphatic plexus is denser in the tendinous portion than that in the muscular portion. The lymphatic lacunae occur exclusively in the muscular portion of the human diaphragm. The lumina of lymphatic lacunae are separated from the peritoneal cavity by a barrier consisting of cuboidal mesothelial cells, endothelial cells of the lymphatic lacunae and intervening connective tissue forming a lymphatic drainage unit. All these three components of the lymphatic drainage unit abut upon each other, but are not linked by specialized junctions. The cuboidal mesothelial cells frequently extend valve-like cytoplasmic processes that bridge the subperitoneal channel and make give it a tortuous course. The fibrous layer of the connective tissue is arranged in fiber bundles and gives a three-dimensional network forming the floor of the peritoneal stomata and the roof of the lymphatic lacunae. Via the fibrous network, the cuboidal mesothelial cells and the endothelial cells of the lacunae come into close contact with each other and form short subperitoneal channels which connect the peritoneal cavity with the subperitoneal lymphatic lacunae. The lymphatic drainage units may regulate the material absorption of the peritoneal stomata from the peritoneal cavity. It is suggested that the peritoneal stomata together with the subperitoneal channels, lymphatic drainage units and lymphatic lacunae comprise an important diaphragmatic lymphatic drainage system which plays an important role in the absorption of materials from the peritoneal cavity.

Cadaveric vascular anatomy for total en bloc spondylectomy in malignant vertebral tumors.

The authors studied the vascular anatomy of the thoracic and lumbar spine in cadavers related to the clinical use of total en bloc spondylectomy in malignant vertebral tumors. To enhance anatomic knowledge on major and associated segmental vessels surrounding the anterior vertebral column of the thoracic and lumbar spine. No reports have, to the authors' knowledge, referred clinically to the anatomic relationship between the vascular system and the anterior vertebral column in performing posterior total en bloc spondylectomy on the thoracic and lumbar spine. The authors studied the major vessels, segmental arteries and veins, and tendinous portions of the lumbar diaphragm inserting onto the vertebrae in 21 cadavers to view the vascular system surrounding the anterior vertebral column in the thoracic and lumbar spine. The aorta descended in direct contact with the anterior vertebral column below T4 or T5 and branched into two common iliac arteries at L3 in one cadaver, at L3-L4 in two, at L4 in eight, at L4-L5 in nine, and at L5 in one. The uppermost intercostal artery originated at T4 or T5, and 48 (14%) variations in 348 intercostal arteries did not originate from the thoracic aorta. Two common iliac veins became confluent at L3-L4 in one subject, at L4-L5 in 13, and at L5 in seven. The inferior vena cava ascended in tight contact with the vertebral column and entered into the vena caval foramen of the diaphragm anterior to the right medial crus. The right medial crus of the diaphragm originated from the vertebra at L1-L2 in one subject, at L2 in two, at L2-L3 in 14, and at L3-L4 in four, whereas, on the left, this ligamentous origin located at L1-L2 in six, at L2 in two, at L2-L3 in 11, and at L3-L4 in two. The first two lumbar arteries ran consistently in the space between the medial crus and the vertebral column. Total en bloc spondylectomy conducted posteriorly is less likely to damage the thoracic aorta from T1 to T4 but, distal to T5, the aorta must be carefully retracted anteriorly before manipulation of the affected vertebra(e). For a malignant tumor involving L1 or L2, the medial and, occasionally, the intermediate crura of the diaphragm and the first two lumbar arteries must be treated carefully before spondylectomy. Malignant tumors involving the L3 and L4 vertebral bodies can be approached with a total en bloc spondylectomy technique only when the inferior vena cava has been safely retracted anteriorly.

Peritoneal-Pleural Communications in Hepatic Hydrothorax Demonstrated by Thoracoscopy

To understand the mechanism of hepatic hydrothorax clearly, thoracoscopy was performed with a flexible bronchoscope. It revealed an intrathoracic influx of ascitic fluid via a bleb and two defects located in the tendinous portion of the right hemidiaphragm and confirmed the existence of transdiaphragmatic peritoneal-pleural communications.

Diagnosis of popliteus injuries with MR imaging

Popliteal muscle and tendon injuries are thought to be unusual. This report describes the magnetic resonance (MR) appearances of popliteus muscle and tendon injuries. The study included 24 patients where the diagnoses of popliteal injuries were prospectively made based on MR appearances. The study group was taken from 2412 consecutive knee MRIs. The injuries were characterized as to involving the muscular or tendinous portions of the popliteus apparatus. In 95.8% (23/24) of patients, the tears of the popliteus involved the muscular portion. The injuries were either partial and interstitial or complete. Three patients had tears of both the muscular and tendinous portions or the tendon alone. The anterior and posterior cruciate ligaments were torn in 16.7% (4/24) and 29.2% (7/24) of patients, respectively. There were medial and lateral meniscal tears in 45.8% (11/24) and 25% (6/24) of patients, respectively. There were injuries of the medial and lateral collateral ligaments in 8.3% (2/24) and 4.2% (1/24) of patients, respectively. Bone bruises and/or fractures were seen in 33.3% (8/24) patients. In 8.3% (2/24) of patients, the popliteus injury was an isolated finding. Popliteus muscle and tendon injuries are not uncommon. They usually occur in conjunction with other significant injuries of the knee and can be characterized with MR imaging.