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  • Journal Highlights

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    February 1, 2018

    Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings

    The unparalleled velocity achieved by overhead throwing subjects the athlete’s shoulder to extreme forces, resulting in both adaptive changes and pathologic findings that can be detected at imaging, according to an online article in the February issue of Radiology (RSNA.org/Radiology).

    Dana J. Lin, MD, from Columbia University Medical Center, New York, and colleagues discuss the epidemiology and biomechanics of throwing injuries.

    The dominant shoulder of the throwing athlete develops an adaptive increase in external rotation through both soft tissue and osseous changes, including asymmetric capsular tightness, with loose anterior and tight posterior capsules, humeral retrotorsion and glenoid retroversion.

    Most shoulder injuries occur at extremes of external rotation, therefore this initially adaptive change can lead to pathologic injury. Glenohumeral internal rotation deficit (GIRD) and internal impingement are closely related entities that explain other associated pathologic findings that can be concurrently seen at imaging, such as superior labrum anteroposterior (SLAP) tears and partial-thickness rotator cuff tears.

    In addition, several less well-known but unique injuries can occur elsewhere around the shoulder, including anterior capsular tears, subscapularis tendon and lesser tuberosity injuries, posterior muscle injuries and glenoid osteochondral injury.

    MRI is the preferred imaging modality for evaluation of overhead throwing patients after initial x-rays. Ultrasound can be used to evaluate for rotator cuff tendinopathy or tendon vascularity, or with dynamic maneuvers, to replicate posterosuperior impingement. CT is helpful to evaluate for osseous pathologic findings, such as a Bennett lesion or lesser tuberosity avulsion.

    “Given the widespread popularity of baseball, and other sports relying on overhead throwing motions at all playing levels from recreational to professional, it is important for radiologists in various practice settings to be familiar with the special mechanisms, locations and types of shoulder injuries seen in the overhead throwing population,” the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Acute Radiologic Manifestations of America’s Opioid Epidemic

    In the wake of the opioid epidemic in the U.S., emergency department radiologists are faced with examining patients who present with complications from either direct drug toxicity or nonsterile injection of the drugs.

    In an article published in the January-February issue of RadioGraphics (RSNA.org/RadioGraphics), David D.B. Bates, MD, from Massachusetts General Hospital and Boston University Medical Center, both in Boston, and colleagues review the opioid-related acute conditions and complications that emergency department radiologists may be responsible for identifying.

    The direct results of opioid abuse may be seen at cross-sectional imaging of the head, neck and spine, where neurologic conditions, including ischemic stroke, cerebral septic emboli, brain abscess, ventriculitis, intracranial mycotic aneurysm, heroin-induced leukoencephalopathy and hypoxic ischemic injury may be noted.

    Cardiopulmonary manifestations include bacterial and fungal infections due to the repeated injection of nonsterile material directly into venous circulation. As venous blood returns to the heart, the cardiac valves, pulmonary vasculature and lung parenchyma may be affected by infective endocarditis, septic pulmonary emboli, pulmonary artery mycotic aneurysm or noncardiogenic pulmonary edema.

    Infectious complications, such as soft-tissue infections and retained needle fragments, are the most common reason (in 60 to 80 percent of cases) for hospital admission due to intravenous or subcutaneous drug injection.

    Intracorporeal concealment of drugs in the gastrointestinal tract or vagina is often seen during imaging. In addition, intravenous drug use predisposes patients to endocarditis and the associated embolic sequelae.

    “Familiarity with the wide range of potential complications associated with opioid abuse will assist emergency radiologists in making timely diagnoses. Prompt diagnoses will aid in giving these patients the best chance for recovery,” the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

    Radiology Podcasts

    Radiology Podcasts
    Radiology Podcasts

    Listen to former Radiology Editor Herbert Y. Kressel, MD, deputy editors and authors discuss the following articles in the December issue of Radiology at RSNA.org/Radiology-Podcasts.

    • “BI-RADS Category 3 Comparison: Probably Benign Category after Recall from Screening before and after Implementation of Digital Breast Tomosynthesis,” Elizabeth S. McDonald, MD, and colleagues.
    • “Feasibility of Dose-reduced Chest CT with Photon-counting Detectors: Initial Results in Humans,” Rolf Symons, MD, and colleagues. “Automated Critical Test Findings Identification and Online Notification System Using Artificial Intelligence in Imaging,” Luciano M. Prevedello, MD, MPH, and colleagues.

    RadioGraphics Podcasts

    Radiology Podcasts

    Listen to RadioGraphics Editor Jeffrey S. Klein, MD, and authors discuss the following articles in recent issues of RadioGraphics at pubs.RSNA.org/RG-Podcasts.

    • “Acute Radiologic Manifestations of America’s Opioid Epidemic,” David D.B. Bates, MD, and colleagues.
    • “Strengths and Weaknesses of Synthetic Mammography in Screening,” Linda Ratanaprasatporn, MD, and colleagues.
    • “Traumatic Hip Dislocation: What the Orthopedic Surgeon Wants to Know,” Jacob C. Mandell, MD, and colleagues.

    The normal total arc of motion in nonthrowers is approximately 180° with equal degrees of external rotation (ER) and internal rotation (IR) (gray arc). To achieve higher velocities, overhead athletes develop adaptive osseous and soft tissue changes that allow for increased maximum external rotation (black arc), which can be detected with passive manipulation of the shoulder at physical examination when the patient is lying supine on the examination table.

    Intracorporeally concealed heroin in a 35-year-old man who was brought to the emergency department after a motor vehicle accident and found to be somnolent. (a, b). Axial (a) and coronal (b) CT images of the abdomen and pelvis show multiple high-attenuating structures (arrows) in the gastric lumen. Bottom right: Photograph shows multiple packets of heroin that were retrieved from this patient at endoscopy. (RadioGraphics 2018; 38;1:109-123) © RSNA 2018. All rights reserved. Printed with permission.