Musculoskeletal vacuum phenomenon. Incidental or pathological finding?

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2017

Poster Number:

C-1059

Type:

Educational Exhibit

Keywords:

Pathology, Education, MR, CT, Conventional radiography, Musculoskeletal soft tissue

Authors:

J. I. Reina Sanchez de Movellan, P. Rubio Murillo, C. Le Cacheux, J. M. Morales Pérez, A. Cano Rodríguez, V. M. Encinas Tobajas, M. Fajardo Cascos; Sevilla/ES

DOI:

10.1594/ecr2017/C-1059

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-1059

Fig. 1: Gas in a patient with necrotizing fasciitis

Fig. 2: Gas related to degenerative disc, which migrates into Schmorl's hernia.

Fig. 4: Gas of vertebral origin in Kümmel osteonecrosis. Patient 1: (A,B). Patient 2:...

Fig. 6: Pneumatocysts. A: C6 vertebral body. B: Physiological PV inside...

Learning objectives

To describe the pathophysiological characteristics and radiological features of the musculoskeletal vacuum phenomenon.

Background

Vacuum phenomenon (VP) refers to the presence of gas in soft tissues or in intraarticular and intraosseous locations. Despite its common occurrence, vacuum phenomenon has not received much focus in the radiological literature with very few bibliographical references.

Findings and procedure details

The vacuum phenomenon (VP) is classified as an abnormal accumulation of gas from the blood serum, in any anatomical area related to the osteoarticular system. It is predominantly composed of Ni with traces of O2 and CO2. The mechanism of its appearance is the result of the transfer of gas from the blood to the surrounding soft tissue due to a negative pressure gradient that sucks gases from the blood stream. It must be distinguished from other pathologies that generate and accumulate air with positive...

Conclusion

The vacuum phenomenon in the musculoskeletal system is produced by transfer of gas from the surrounding soft tissue into a negative pressure zone. Its appearance usually has pathological significance when it appears in degenerative disc spaces, in the bone marrow of osteonecrotic vertebrae, or in fractures complicated with pseudoarthrosis. On the contrary, it should not necessarily be interpreted as abnormal when observed in any of the joints where distraction forces are usually generated, such as the knee, sacroiliac, pubis, sternum-clavicular, acromio-clavicular, glenohumeral, wrist or ankle.

Personal information

References

1>Maldague, B. E., Noel, H. M., & Malghem, J. J. (1978). The Intravertebral Vacuum Cleft: A Sign of Ischemic Vertebral Collapse 1.Radiology,129(1), 23-29. 2>D’Anastasi, M., Birkenmaier, C., Schmidt, G. P., Wegener, B., Reiser, M. F., & Baur-Melnyk, A. (2011). Correlation between vacuum phenomenon on CT and fluid on MRI in degenerative disks.American Journal of Roentgenology,197(5), 1182-1189. 3>Resnick, D., Niwayama, G., Guerra Jr, J., Vint, V., & Usselman, J. (1981). Spinal vacuum phenomena: anatomical study and review.Radiology,139(2), 341-348. 4>Karantanas, A. H. (2001). CT and MR imaging...