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