Preliminary Diagnosis: Pes Anserine Bursitis
Pes Anserine Bursitis
I. What imaging technique is first-line for this diagnosis?
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MRI
II. Describe the advantages and disadvantages of this technique for diagnosis of pes anserine bursitis.
Advantages
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Able to detect other causes of pain or weakness in the joint such as tendonitis, tenosynovitis, or tears of the tendons of the pes anserinus (sartorius, gracilis and semimembranosus)
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Exclude connection to medial meniscus and joint effusion with good certainty
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Does not make use of any ionizing radiation
Disadvantages
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Expensive
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact
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Intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case by case basis with a GFR greater than 30 and less than 60
III. What are the contraindications for the first-line imaging technique?
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Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodies
IV. What alternative imaging techniques are available?
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Ultrasound
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CT with or without contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pes anserine bursitis.
Ultrasound
Advantages
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Able to detect fluid collection and whether fluid is simple or complex.
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Optimal modality for concomitant detection and aspiration of fluid if indicated
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Relatively inexpensive
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Portable imaging modality
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Does not use ionizing radiation
Disadvantages
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Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology
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Limited evaluation in obese patients
CT with or without contrast
Advantages
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Able to see fluid-filled bursa in its typical location
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Further detail of bone if fracture or osseous lesions suspected
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Performed much more quickly than MR imaging
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Requires less patient cooperation and is associated with less motion artifact than MR imaging
Disadvantages
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Soft tissue structures and tendons better evaluated with MRI
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Exposes the patient to a large amount of ionizing radiation
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Imaging with intravenous contrast requires that the patient have good renal function with a creatinine of 0.6-1.2 mg/dL for an adult
VI. What are the contraindications for the alternative imaging techniques?
Ultrasound
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No significant contraindications exist
CT with or without contrast
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Contraindicated in a pregnant patient, especially within the first two trimesters
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Relative contraindication in patients with a contrast allergy
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Relative contraindication in patients with renal failure
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